Cosmos Tryout Registration Form

Cosmos Tryout Registration Form

Registering does not commit you to the club. This is only for fall tryouts. Club registration will be completed after tryouts.
Saturday, May 10 - 5 to 7 pm

Pine Fork Park
Player Name*

First NameLast Name
Gender*

MaleFemale
Guardian / Parents Names*

First NameLast Name
Birth Year*
Fall 2025 School Year*
Player Shirt Size*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Cell Phone*
Parent E-mail*
example@example.com
Current Soccer skill level*

1

2

3

4

5

1 is Rec, 5 is Elite
What team level are you hoping to be placed on?*

Travel/EliteClub/PremiereTraining OnlyOther
Parents Interested in Volunteering?

Assistant CoachTeam ManagerScheduling CoordinatorSocial Media ManagerOther
Additional information we should know:
Important Notes

·  Wear BLACK shirt

·  Shin guards are required

·  Bring water

·  Clean-up after yourself
Emergency Contact
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo
Please describe*
Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to the facility listed below.

I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Release of Liability

Although the safety of all sport activities is the primary concern, all sports activities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the NK Cosmos SC or New Kent County and the persons in charge.
I have read and agree to the above conditions*

YesNo
Confirmation E-mail*
example@example.com
Signature*

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Cosmos Tryout Registration Form

Saturday, May 10 - 5 to 7 pm

Emergency Contact

Release of Liability