Penn United - Interested in Travel/Premier Program
Please complete this form if you are interested in playing on a travel or premier team.  Our Director of Coaching, Danny Orton will be in touch with you share additional information and to schedule a time for evaluation.
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Player's first and last name *
Parent Name *
Parent Phone Number *
Parent's e-mail address *
Player's birth date *
Player's current age *
Gender *
How did you learn about Penn United?
Recognizing the possibility of physical injury associated with soccer and in consideration for the USSF/USYSA/EPYSA/STN West/Penn United Soccer Academy/USCLUBSOCCER and its affiliates accepting the registrant for its soccer programs and activities (the "Programs"), I hereby release, discharge and/or otherwise indemnify the USSF/USYSA/EPYSA/STN West/Penn United Soccer Academy/USCLUBSOCCER, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs against any claim by on or behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. My son/daughter has received a physical examination by a physician and has been found physically capable of participating in the Programs. I hereby give my consent to have an athletic trainer and/or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of such assistance and/or treatment. *
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