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competitive placement Registration form

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Player Information

Birth Date   format: YYYY-MM-DD
Age:            Age Group:     (automatically filled in for you)
First Name: A value is required. Last Name:   A value is required.
Address: A value is required.
City: A value is required. State:          Zip: A value is required.Invalid format.
Phone: A value is required.Invalid format.    (Format: 916-555-1212)
Field Position: Forward    Midfield    Defense    Goal Keeper
Club/Team Played on Last Season:
Parent Information
First Name: A value is required.

Last Name:   A value is required.
Email: A value is required.Invalid format.
Phone: A value is required.Invalid format.  (Format: 916-555-1212)     Cell Phone:   A value is required.Invalid format.
 
Address:
  Mark here if address is the same as player's information
   Street:
   City: State:   Zip:
Emergency Information
Emergency Contact: A value is required.
Emergency Phone: A value is required.Invalid format.    (Format: 916-555-1212)
Doctor to Notify: A value is required.
Doctor Phone: A value is required.Invalid format.
Parent/Guardian Waiver
DISCLAIMER, ASSUMPTION OF RISK AND WAIVER: I, the undersigned parent or legal guardian of the above player, a minor, acknowledge that participation in soccer involves risk of severe, permanent physical injury, and death. For myself, and on behalf of the above player, we willingly and voluntarily accept and assume all such risk. In consideration of permitting the voluntary participation of the above-named participant in this tryout program, for myself and on behalf of the above player, I hereby release, discharge and agree to hold harmless EDYSL, its employees, volunteers, officials, sponsors, and other representatives from any and all claims, demands, costs, expenses, and compensation arising out of or in any way related to any injury or other damage that may result to said participant while participating in any EDYSL sponsored event, including any physical or other injury caused by the negligence of any such person while performing his/her duties at any time.
I HAVE READ THE DISCLAIMER, ASSUMPTION OF RISK, AND WAIVER AND FULLY UNDERSTAND THE TERMS OF EACH. I UNDERSTAND THAT I AND THE ABOVE PLAYER HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY AGREEING TO THESE TERMS, AND AGREE TO THESE TERMS FREELY AND VOLUNTARILY AND WITHOUT INDUCEMENT FOR MYSELF AND ON BEHALF OF THE ABOVE

                                                                 
Please make a selection.