Everett Soccer Junior Academy Fall 2019 Registration Form
Below is the registration information for the Everett Soccer Junior Academy Program. Tailored for children ages 4-8 or in Grades Pre-K to 3rd grade. This is solely the registration form and a payment of $80 must be submitted in the form of cash or check issued to Everett Soccer Club. Please fill out an individual registration form for each child, each additional child registered is subject to a $20 discount. Registration is only complete when a payment is submitted the first week of practices. Start date is September 9. For more questions, please contact everettsoccerpresident@gmail.com
Email address *
Player Full Name *
Your answer
Player Date of Birth *
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Player Gender *
Age Group *
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
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. *
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. *
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