Everett Junior Academy Registration Spring 2019
This is the registration for Everett Soccer Club Junior Academy, for players aged 4-8 participating in the In-Town program. The registration cost is $60 and can be paid in person via cash or check issued to Everett Soccer Club. Players cannot begin participating until a payment is submitted.
Player Name *
Your answer
Player Date of Birth (DOB) *
MM
/
DD
/
YYYY
Player Gender *
Parent/Guardian Name *
Your answer
Email
Your answer
Address
Your answer
Phone number *
Your answer
By checking the box below, I, the parent/guardian of the registrant, recognize the possibility of physical injury associated with soccer and accept the registrant for its soccer programs and activities. I hereby release, discharge and/or otherwise indemnify the USYSA, and its affiliated organization and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the programs, against any claim or on the 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. *
Required
As parent or legal guardian of the above named player, I hereby consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well being of my dependent. *
Required
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