Long Island City Youth Soccer Academy Registration Form-Travel
*No Refunds
Email address *
Player's First Name *
Your answer
Player's Last Name *
Your answer
Player's date of birth *
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Address: *
Your answer
City, State, Zip *
Your answer
Telephone number: *
Your answer
Email address: *
Your answer
Parent/Guardian's First Name: *
Your answer
Parent/Guardian's Last Name: *
Your answer
Please Check the program you are registering for: *
Required
Yearly membership valid from date: *
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Consent to photograph, film, or videotape: I hereby authorize Long Island City Youth Soccer to take photographs or video footage, electronic images or movies of my child or us participating in the program and to use same in promotional or advertising materials for Long Island City Youth Soccer flyers, on the internet, and all other forms of media, and we waive any right to compensation or other rights related to such use. I acknowledge that I have read and understand and agree to all of the above terms and conditions of the Long Island City Youth Soccer program. *
Required
RELEASE OF LIABILITY: I agree by signing below that I wave the risk of any type of injury that may occur during the games or training sessions of Long Island City Youth Soccer while I am participating. I hereby release waive discharge and covenant not to sue Long Island City Youth Soccer, its owners, promoters, sponsors, officials and employees involved in organizing this event. I also assume full responsibility for any loss, liability, death or cost that may incur due to the negligence or the result of any action by them, around or upon the playing areas while they or and/or I am competing, participating and observing working for and/or any other way associated with the event within premises. *
Required
I understand that Long Island City Youth Soccer reserves rights to suspend or expel any player from the club for any type of in disciplinary action including excessive absences. I also understand that once player joins Long Island City Youth Soccer there will be no membership refund applicable. *
Required
A copy of your responses will be emailed to the address you provided.
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