2025-2026 LoN Season Registration Form

2025/26 PLAYER REGISTRATION FORM

League of Nations Soccer Academy Program - By Revival Sport

Player Name*

First NameLast Name

MaleFemale

Date of Birth*

MonthDayYear
Date

School/Location*

Grade*

Player's T-shirt Size*

Player's Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Does he/she have any injuries? *

If yes, please describe.

Does he/she have any health conditions we should know about?*

If yes, please describe.
(High blood pressure, allergies, asthma, diabetes, any heart issues, etc.)

Has he/she played soccer before?*
Please select yes or no.

If yes, for how long?

Parent / Guardian Information

Parent Name*

First NameLast Name

Parent Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Parent's Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

What is the best way to contact you?*
How can we find you on Facebook?
(Optional)

Emergency Contact Information

Emergency Contact Name*

First NameLast Name

Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Relationship To Player*

Today’s Date*

MonthDayYear
Date
Parent / Guardian Signature*

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Waiver and Release of Liability

Must be signed to complete registration.

EXPRESS ASSUMPTION OF RISK: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include, but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, my training partner, or other people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under the direction of Revival Sport Inc
I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.
RELEASE: In consideration of the above-mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by Revival Sport Inc. I, the undersigned hereby release Revival Sport Inc., their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above-mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.
If I am signing on behalf of a minor child, I also give full permission for any person connected with Revival Sport Inc. to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.
INDEMNIFICATION: The participant recognizes that there is risk involved in the types of activities offered by Revival Sport Inc. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above-mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Revival Sport Inc., their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Revival Sport Inc., at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to the main building, and/or any area selected for training by Revival Sport Inc.
I have read and understood the foregoing assumption of risk and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission.
I understand that by signing this form I am waiving valuable legal rights.

Parent/Guardian Initials*
(example: L.C.)

Photography/Video Release

Social Media Release Form
Participants involved in any activities offered by Revival Sport Inc. may be photographed or videotaped during training and games.
Do you consent to the use of these photographs and/or videos of your child being used on the website or in any editorial, promotional, or advertising material produced and/or published by Revival Sport Inc?

Parent/Guardian Name*

First NameLast Name
Parent Signature*

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Today’s Date*

MonthDayYear
Date

League of Nations 2025-26 Season

Practice times and locations

All Practices start the week of Sept 15th, 2025 and will be from

4:30-6pm

Albright Middle- Every Monday @ Miller Intermediate

Miller Intermediate- Every Tuesday @ Miller Intermediate

Holmquist Elementary- Every Wednesday @ Miller Intermediate

Rees Elementary- Every Thursday @ Miller Intermediate

Petrosky Elementary- Every Thursday @ Miller Intermediate

Liestman Elementary- Every Thursday @ Liestman Elementary

Youngblood Intermediate- Every Thursday @ Liestman Elementary

Owens Intermediate- Every Monday @ Bush Elementary

Bush Elementary- Every Tuesday @ Bush Elementary

Sneed Elementary- Every Tuesday @ Bush Elementary

Collins Elementary- Every Wednesday @ Bush Elementary

Best Elementary- Every Wednesday @ Bush Elementary

Chambers Elementary- Every Thursday @ Bush Elementary

Chancellor Elementary- Every Thursday @ Bush Elementary

Higher Dimension Church/Hope Court- Every Monday @Higher DImension Church

Miller Address: 15025 Westpark Dr Houston, TX 77082

Bush Address: 9730 Stroud Dr Houston, TX 77036

Liestman Address: 7610 Synott Rd Houston TX, 77083

Higher Dimension Church: 9800 Club Creek Dr Houston, TX 77036

Please push SUBMIT.

Welcome to the League of Nations team!
Should be Empty:

2025/26 PLAYER REGISTRATION FORM

Parent / Guardian Information

Emergency Contact Information

Waiver and Release of Liability

Photography/Video Release

Please push SUBMIT.