Rush Canada Soccer Academy
Try Out Registration Form
City *
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Personal Information
Postal Code *
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Street Address *
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Player Birthday *
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Player Full Name *
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Work Phone Number
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Cell Phone Number *
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Home Phone Number
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Gender *
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Email Address *
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Player Information
Please enter any clubs that you currently or formerly played for
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Level of Play *
Parent Name *
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Parent Information
Parent Cell Phone *
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Spouse Cell Phone
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Player Position *
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Additional Notes
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Spouse Name
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Request Information
Please select the program you wish to try out for. Once you submit your form, a member of our staff will contact you with more information.
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Please Read Carefully
The undersigned parent or guardian represents that the player is in good health and can participate in competitive soccer.

I Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used, and acknowledge further, that there may be other risks not known or not responsibly foreseeable at this time;

Assume all foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death. Release, waive, discharge and covenant not to sue Rush-Canada Soccer Academy Inc., or teams and their respective administrators, directors, agents, coaches, and other employees of the organizations, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leaser’s of premises used to conduct the event, all of which are hereinafter, referred to as “Releases” from demands; losses or damages on account of injury, including death or damages to property, caused or alleged to be caused in whole or in part by the negligence of the “Releasee” or otherwise.

Parent/Guardian Full Name *
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