Park City SC 2016 Practice Roster Registration
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Parent's Name *
Your answer
Players Name *
Your answer
Birth Year (YYYY) *
Your answer
Birth Month / Day *
MM
/
DD
Gender *
Team - Practice Roster *
Grade Level Next Year *
School Attending Next Year
Your answer
Email *
Your answer
Primary Phone *
Your answer
Secondary Phone *
Your answer
Mailing Address *
Your answer
PARENTAL CONSENT TERMS
I hereby give my permission for my son/daughter to participate in tryouts for the Park City Soccer Club, an affiliation of the Utah Youth Soccer Association (UYSA). As a parent/guardian, of the minor participant, I agree that the participant will abide by the rules of the Park City Soccer Club and its affiliates. I do further release any and all Park City Soccer Club and UYSA officers, employees, property owners against any claim or action on behalf of the named participant. I understand all Park City Soccer Club fees are payable in advance and are non-refundable.
CONSENT FOR MEDICAL TREATMENT TERMS
As a parent or legal guardian of the above-named registrant, I hereby give my 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 deemed necessary to preserve life, limb or well-being of the registrant.
PARTICIPATION RISK STATEMENT TERMS
As a parent or legal guardian of the above-named registrant, I fully understand that that participating in the sport of soccer presents a risk of serious injury or death. In my capacity as parent or legal guardian, I understand the risks and responsibility to notify the other parent or legal guardian as well as the minor of the risks involved with sport participation. I have made a conscious decision to allow the named minor to play. I agree that my health & accident insurance will be the primary insurance to cover expenses for any such injury, including rehabilitation.
AGREEMENT *
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