Grassroots  Registration Form 2026/2027 Indoor  Season 


PLEASE COMPLETE ONE REGISTRATION FOR EACH CHILD. NO EXCEPTIONS. 
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Email *
Check box for your Child's Birth Year *
Required
Child's First Name *
Child's Last Name *
Child's Gender *
Child's Birthday *
MM
/
DD
/
YYYY
Child's Home Address (Street, City, Postal Code) *
Name(s) of Parents/Guardians *
Email Address (Note: Email is our main way to communicate with you, so please double check for accuracy) *
Main Phone Number ###-###-#### format *
Alternate Phone Number (Optional)
Disclaimer 1: In consideration of acceptance of this registration, I, for myself, my child and anyone claiming for my child or myself (collectively "we") hereby waive all claims we may have at any time against the FC Viktoria, EMSA, and ASA (the soccer organizations), or any other director or officer or member of any of them, soccer coordinators, coaches, referees, or other persons assisting in the soccer organization's soccer programs, and I indemnify the soccer organizations and individuals for any such claims made against them on behalf of my child or anyone. *
Disclaimer 2: I hereby, also, consent to the disclosure of information provided herein to officials of  FC Viktoria and EMSA (FC Viktoria is part of EMSA) the use of photographs/videos taken of my child that may be used for promotional purposes on the  FC Viktoria and EMSA websites and FC Viktoria social media pages. *
A copy of your responses will be emailed to the address you provided.
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