VC Fusion YSA Simi Valley, Moorpark & Thousand Oaks Tryout Form
The Ventura County Fusion YSA will be hosting official youth club and Pre-Academy teams in the Conejo Valley for the current season. We are hosting trials this February 22nd & March 1st and currently recruiting players within the age groups from 2011-2004. Players of all levels are encouraged to trial as we will have various teams to roster.
Email address *
Player's Full Name *
Your answer
Birthdate *
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DD
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YYYY
Gender *
Playing Experience (Please List All Clubs Player Has Played For) *
Your answer
Parent/Guardian (Full Name) *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Phone Number 2
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code
Your answer
How did you hear about us? *
Your answer
Waiver
We, the registrant and the registrant's legal parent or guardian, Recognize the possibility of physical injury associated with soccer and in consideration for the Ventura County Fusion accepting the player for its soccer program (“Program”), I hereby release, discharge and/or otherwise indemnify Ventura County Fusion, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Program, against any claim by or on behalf of the player as a result of the players participation in the Program. 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 necessary to preserve the life, limb or well-being of my dependent. I hereby give my consent to Ventura County Fusion to take photographs, video recordings, and/or sound recordings of the above named player in documenting the activities of Ventura County Fusion programs. I grant Ventura County Fusion permission to use the negatives, prints, motion pictures, video/audio tapings, or any other reproduction of the same for educational and promotional purposes in manuals, on flyers, on the world wide web, or in other publications. We have read this release and waiver of liability and fully understand its terms. We understand that we waive substantial rights by signing this form. We agree to waive all such rights above including the right to file a legal action or assert a claim for personal or physical injury or death of any kind. We sign this release form freely of our own free will.
Please Check box to confirm you have read, understood and agree to comply with the Mission Statement Waiver as outlined above. *
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