SI United 2016-2017 Tryout Registration
Please complete this form to register for the tryouts
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Player's First Name *
Player's Last Name *
Gender *
Required
Player's Date of Birth *
MM
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DD
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YYYY
Address *
Zipcode *
5 digit code only
Brief Playing History *
Current Team Name *
Parent/Guardian *
Last, First
Relationship to Player *
Parent/Guardian's E-Mail Address *
Parent/Guardian's Cell # *
Medical Release
Recognizing the possibility of physical injury associated with soccer and in consideration for SI United accepting  the registrant for its soccer programs and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify SI United, its affiliated organizations and sponsors, their employees and associated personnel, including the owner of fields and facilities utilized for the Programs against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. My son/daughter has received a physical examination by a physician and has been found physically capable of participating in the Programs. I hereby give my consent to have an athletic trainer and/or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the cost of each assistance and/or treatment.
Name of Parent or Guardian *
Date *
MM
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DD
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YYYY
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