ACADEMY NEW MEMBER REGISTRATION

Inter Bakersfield Soccer Academy

New Member form
Jan- Dec 2026 Season
Player's Name

First NameLast Name
Player's Date of Birth

MonthDayYear
Date
PLACE OF BIRTH
Does Player has double Nationality?
Yes, What Country
Name of School
Player's Current Grade?
Size of Shirt
Short Size
Parent Name

First NameLast Name
Parent Number

Area CodePhone Number
Parent's Email
example@example.com
Player's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Player Health Insurance Information
Does the player have health insurance?
Insurance Details (Show ONLY if “Yes” is selected) Health Insurance Company/ name of the provider that covers the child.
IF NO,

I understand that my child does not have health insurance and I accept full responsibility for any medical expenses.

I acknowledge that my child does not have health insurance. I accept full responsibility for any and all medical expenses resulting from participation in Inter BK Soccer Academy activities, including practices, games, and related events.

I agree to release and hold harmless Inter BK Soccer Academy, its coaches, staff, volunteers, and board members from any and all financial liability related to such medical expenses.
Parent Signature
Parent Name

First NameLast Name
Date

MonthDayYear
Date
Required Documents for Registration
To finalize your child’s registration, the following documents must be completed, signed, and submitted:

- Liability Waiver, Medical Release & Assumption of Risk

- Academy member registration

All required forms can be found on our website:
www.interbk.org
Should be Empty:

Inter Bakersfield Soccer Academy