WOMEN’S PROFESSIONAL FUTSAL IS HERE!

WOMEN’S PROFESSIONAL FUTSAL IS HERE!

Use this form to register for open tryouts for:
Portland City Futsal Club (PCFC),
Portland’s first and only Women’s Professional Futsal Team. Gateway to the Women’s National Futsal Team.

Oregon Premier Futsal’s (OPF),
Women’s Premier Futsal Team and/or the OPF Futsal Academy. Pathway to the pro's ... player development to prepare to play at the highest level of Futsal.

All other tryouts for the professional and premier teams will be by invite only.

Open tryout will be: 2/18/2017
Start time: 4 pm to 6 pm
(reccomend arriving 30 minutes early)

Location: OREGON PREMIER FUTSAL
12402 SE Jennifer St. #190 Clackamas, OR 97015
Phone: 503-905-5023

Athlete Information

Athlete's Name

First NameLast Name

Birth Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Portland City Futsal Club (PCFC) and Oregon Premier Futsal's (OPF) main goal is to grow the sport of Futsal in the the Pacific Northwest by offering many options for players to develop. You can select one of all three of the below options below if you are interested in all three opportunities. You must be U14 (born in 2004) to U19 (born in 1999) to be in the OPF Womens Futsal Academy.

Portland City Futsal Club Women's Professional TeamOregon Premier Futsal's (OPF) Premier TeamOPF Women's Futsal Academy U14 to U19

Shirt size*

Parent/Guardian Information (if a minor)

Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail

Emergency Information

Emergency Contact's Name

First NameLast Name

Phone Number

Area CodePhone Number

Relationship

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

There will be a $35 registration fee. Each player will recieve a Portland City Futsal Club T-shirt at the tryouts.

Registration Payment

Try-Outs$35.00

Credit Card

Informed Consent and Acknowledgement

I hereby give my approval for my daughters participation in any and all activities prepared by PCFC and OPF during tryouts. In exchange for the acceptance of said daughters candidacy by PCFC and OPF, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless to PCFC and OPF and all its respective officers, agents, and representatives from any and all liability for injuries to said daughter arising out of traveling to, participating in, or returning from tryouts.

In case of injury to said daughter, I hereby waive all claims against PCFC and OPF including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including Futsal. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent/Attendee and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to PCFC and OPF and its affiliates including Directors, Coaches, Participants and Team Parents to provide the needed emergency treatment prior to the admission to the medical facility.

Release authorized on the dates and/or duration of the tryouts. In event the payer is placed on a team this realease and authorization would apply until the player is removed from the teams training roster or player rosters.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence or the player participant.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.