2019 Tryouts
Email address *
Player First Name *
Your answer
Player Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Phone *
Your answer
Gender *
Home Address *
Your answer
How did you hear about ASA/USA? *
Your answer
Prior soccer club(s)? *
Your answer
Parent / Guardian Consent
CONSENT FOR MEDICAL TREATMENT (MINOR): As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care prescribed by a Doctor of Medicine or Doctor of Dentistry. Care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent. I further request that in my absence the above-named player be admitted to any hospital or medical facility for diagnosis/treatment. I authorize all diagnostic/treatment/operative/x-ray procedures of the above minor. I have not been given a guarantee as to the results of examination/treatment. I authorize disposal of any specimen or tissue taken from the above minor. This consent and authorization does not expire.
I, THE PARENT OR LEGAL GUARDIAN UNDERSTAND AND AGREE TO THE FOLLOWING: I am not guaranteed a specific coach, practice/game/session, time, day or location.
IMPORTANT: I, the parent/legal guardian of the above-named player, a minor, agree that I and the player will abide by the rules and regulations of the USYSA, its affiliated organizations and its sponsors (“USYSA Parties”). In consideration of the player’s participation in the soccer programs and activities, including but not limited to athletic and social events of the USYSA Parties (“the Programs”) and Arizona Soccer Academy, Inc. and United Soccer Academy, Inc., I, for myself and the player and our respective heirs, administrators and successors, intending to be legally bound, hereby release and indemnify the USYSA Parties and Arizona Soccer Academy, Inc. and United Soccer Academy, Inc., owners, operators, coaches / trainers, independent contractors, the owners and operators of the facilities used for the Programs, and their respective directors, officers, employees, agents, independent contractors and representatives from and against all claims, liabilities, damages or causes of action arising out of or in connection with the player’s participation in the Programs including, without limitation, player’s transportation to/from any Program, which transportation is hereby authorized. I further grant the USYSA Parties, Arizona Soccer Academy, Inc., United Soccer Academy, Inc. and all above mentioned parties the right and permission to use names / photograph(s) / likeness / video of the below named player and myself in any and all printed, broadcast or other publications and all other media, whether now known or hereafter existing, in perpetuity, and for other use by Arizona Soccer Academy, Inc. and United Soccer Academy, Inc. I will make no monetary or other claim against Arizona Soccer Academy, Inc. and United Soccer Academy, Inc. for the use of information and photograph(s) / video. This consent and authorization does not expire.
My entry of the information above and my checking the acceptance box of this agreement shall be my signature to authorize and execute this agreement. This authorization does not expire.
My entry of the information above and my checking the acceptance box of this agreement shall be my signature to authorize and execute this agreement. This authorization does not expire. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service