Junior Roots Clinic Registration | Fall 2026
Register your child for free Rising Roots pre-match youth soccer clinics (ages 5–13) and select your child’s availability Fall 2026
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Full Name
*
First Name
Last Name
Child's Age (must be 5-13)
*
Child's Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
ZIP Code
*
Primary Address Zip code
Player School District
*
This is to track the areas being served
Soccer Experience Level
*
None
Beginner
Recreational
Competitive
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relevant Allergies, Medical Considerations, or Accommodations (optional)
How did your family hear about Rising Roots Initiative?
*
Please Select
School
Friend/Family
Social Media
Community Event
Capital City Roots FC
Other
Which Junior Roots Clinic(s) would you like to attend?
*
Sunday, October 25 — 3:30 PM–4:15 PM — Waukee High School — Capital City Roots FC vs Reapers at 5:00 PM
Sunday, November 8 — 3:30 PM–4:15 PM — Waukee High School — Capital City Roots FC vs Heartland at 5:00 PM
Sunday, November 15 — 3:30 PM–4:15 PM — Waukee High School — Capital City Roots FC vs Omaha Street at 5:00 PM
Participation & Liability Waiver: I acknowledge that participation in the Junior Roots Clinic is voluntary and agree to the terms and conditions outlined by Rising Roots Initiative.
*
Emergency Medical Authorization: I authorize Rising Roots Initiative to seek emergency medical care for my child if necessary during clinic activities.
*
Photo/Video/Media Release: I consent to my child's image being used in media and promotional materials by Rising Roots Initiative
*
Yes, I consent
No, I do not consent
I confirm that I am at least 18 years old and authorized to register this child for the Junior Roots Clinic.
*
I would like to receive future Rising Roots Initiative clinic and program announcements (optional).
Yes, send me updates
Register
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