Youth Soccer Registration Form

Youth Soccer Registration Form
About

We will be running an 8-week soccer camp starting March 30th until May 11th for elementary aged children. Practice will be held on Sundays from 2:00 pm - 3:00 pm (time subject to change based on coaching availability - we will have more confirmation closer to starting date) at the Sayward School Field. Please provide your child with appropriate weather permitting clothing, soccer gear (cleats and shin guards), as well as a water bottle. We will provide access to fresh water, first aid, balls and equipment. All coaches and volunteers will provide a criminal record check as well as all coaches hold Level 1 First Aid certification and previous soccer training ⚽️ If you would like to make a donation for equipment, please reach out to Hali Samuels. We look forward to a great start to an ever growing sports experience for our children!
Athlete Information
Athlete's Name*

First NameLast Name
Birth Date*

MonthDayYear
Age
Gender

MaleFemalePrefer not to say
Would you like to register a second athlete?*

YesNo
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Age
Gender

MaleFemaleOther
Would you like to register a third athlete?*

YesNo
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Age
Gender

MaleFemaleOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*
Alt. Phone Number
Shirt size for athlete(s)
Does the athlete(s) have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the athlete(s) prescribed an inhaler? If yes, please explain any instructions.
Any other comments or concerns.
Informed Consent and Acknowledgement

I hereby provide my consent for my child's participation in all activities organized by the soccer coach during the chosen camp session. By accepting my child's participation, I acknowledge and accept all the potential risks and hazards associated with these activities. I release, exempt, and indemnify the soccer camp and all its officials, representatives, and agents from any responsibility for injuries that may occur to my child(ren) during their travel to, engagement in, or return from the sessions.

If my child(ren) sustains an injury, I waive any claims against the soccer facilitators, including its coaches, volunteers, fellow participants, supporting organizations, advertisers, and, if applicable, the owners and landlords of the premises where the event is held. Engaging in sports activities, including soccer, inherently carries a risk of injury, which may include but is not limited to fractures, paralysis, or even fatality.
Signature*

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Medical Release and Authorization

As the legal guardian of the youth athlete(s) listed, I hereby grant permission for qualified and licensed medical professionals to diagnose and administer treatment in the event of a medical emergency. This authorization is applicable when, in the medical professional's judgment, immediate attention is necessary to prevent further harm to the minor child's life, physical appearance, physical functionality, or to alleviate undue pain, suffering, or discomfort should there be a delay in treatment.

I hereby give consent to the attending physician to undertake any necessary medical or minor surgical procedures and conduct X-ray examinations to the youth athlete(s) named. In cases of a serious illness, the requirement for major surgery, or significant accidental injury, I am aware that the attending physician will make every reasonable effort to contact me as swiftly as possible before proceeding with treatment. This authorization is granted after a reasonable attempt has been made to reach me.

I also authorize the affiliated individuals, including Directors, Coaches, and Team Parents, to provide essential emergency treatment before the child(ren) is admitted to a medical facility.

This consent is valid during the dates and for the duration of the registered season. I willingly provide this authorization to ensure prompt medical treatment under emergency circumstances, safeguarding the life and well-being of the named minor child(ren) when I am not present.
Signature*

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Youth Soccer Registration Form

About