Action Indoor 25/26 Winter Youth League Registration Form

Action Indoor 25/26 Winter Youth League Registration Form

Season runs from December 25 to February 2026
Player Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Contact Phone Number*

Area CodePhone Number
Are you already on a team or have a coach that you want to play with?
(place name of coach or team here if you are already a member of a team)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Indoor Soccer Application Information
Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Relation to Athlete
Confirmation

I hereby affirm in giving consent to let my child be given immediate treatment and care by any qualified medical personnel in circumstances which may need immediate attendance and care.
Clinic / Hospital
Name of Family Doctor

First NameLast Name

Medical Information
In case the parent/guardian is out of reach at the time of emergency, with consent of the latter, we will exercise the required diligence needed to have the athlete treated by an E.R Physician. In this regard, we would like to get to know any precautions that we need for the athlete
Any Allergies to Medicine and Antibiotics?
Medications*

Parental/Guardian Consent
Waiver

I am aware that any physical sport activity may cause accidental injury or harm among the athletes, and I assume any and all possible risk that may cause injury, illness, or death arising to such activity. I agree to waive my right to pursue any claim against the Commission and the Organizing Committee of this event and Action Indoor Sports and its Employees and owners.
Signature of Parent / Guardian

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Name

First NameLast Name
Should be Empty:

Parental Information