• Program Details

  • REGISTRATION FORM

    Worcester City Soccer Academy
  • Worcester City Football Academy is a youth soccer development program for boys and girls ages 5–13 focused on skill development, confidence, teamwork, discipline, and fun.

    📍Outdoor Location: Elm Park Elementary School – 23 N Ashland St Worcester, MA

    📍 Indoor Location: ACE Gym - 51 Gage Street Worcester, MA 01605


    📅 Training Days: Fridays


    ⏰ Time: 6:30 PM – 8:00 PM

  • Clinic Selection
  • PLAYER INFO

  • Gender
  • Photography Consent:

     

    Dear Parent/Guardian,

    During Worcester City Soccer Academy programs, clinics, camps, and training sessions, we may take photos and videos of players participating in activities. These photos and videos help us share positive moments, program updates, and highlights from our academy.

     

    Your child may appear directly or indirectly in photos or videos taken during Worcester City Soccer Academy activities.

    These images may be used on our website, social media pages, flyers, newsletters, promotional materials, and other academy-related platforms.

     

    By selecting your choice below and submitting this form, you give Worcester City Soccer Academy permission to use photos or videos that may include your child.

  • Please select one:
  • Liability & Medical Consent

    I hereby authorize the directors, coaches, and staff of Worcester City Soccer Academy to act on my behalf according to their best judgment in the event of an emergency requiring medical attention.

    I understand that participation in soccer activities involves physical activity and some risk of injury. I hereby waive and release Worcester City Soccer Academy, its directors, coaches, staff, volunteers, and facility partners from liability for any injuries, illness, or accidents that may occur while attending or participating in Worcester City Soccer Academy programs, clinics, camps, training sessions, or events.

    I confirm that, to the best of my knowledge, my child has no medical or physical condition that would prevent them from safely participating in this program. I understand that I am responsible for any medical costs, treatment charges, or other expenses related to my child’s participation.

    In addition, I give permission for minor treatment or first aid to be performed on my child by on-site professionals or staff, if available and necessary.

    By submitting this form, I acknowledge and agree that Worcester City Soccer Academy and its staff will not be held liable for injuries or illness suffered during academy activities.

  • CONTACT INFO

  • Format: (000) 000-0000.
  • Medical Release and Authorization

    As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

    Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

    Permission is also granted to the Worstar and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

    Release authorized on the dates and/or duration of the registered season.

    This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

  • Payment Method

  • Please select your preferred payment method:
  • Payment Options

  • Note: Payment must be completed before or at the start of the session.

  • Confirmation / Electronic Signature Agreement

    By acknowledging and signing below, I understand that I am providing an electronic signature. This electronic signature has the same legal effect as an original handwritten signature and is equally binding.

    I confirm that I have read, understood, and agree to the terms of this form.

     

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