Player Registration Form Player Information Player Name * First Name Last Name Age * Gender * Male Female Position * Years of Soccer Experience * Team/Program Currently Playing For Contact Information Parent/Legal Guardian Name * First Name Last Name Contact Phone Number * Contact Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Signatures, Disclaimers and Terms of Agreement Medical Emergency * I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. I agree Medical Expenses * I understand that the Shearer Soccer Academy and/or its Staff will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. I agree Photo Release * I understand the photos will be used to keep a journal of activities, to share during power point presentations, for promotional purposes including flyers, brochures, newspapers and social media. I agree Terms * The Shearer Soccer Academy and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. The child’s photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician). I agree Signature Name * First Name Last Name Date * MM DD YYYY Thank you!
