Please Note: You child is not signed up until fees are paid

Sign Up for soccer

Parent First Name
Parent Last Name
Parent Email:
Alternate Email:
Street Address:
Mom Cell:
Dad Cell:
Home:
Child's First Name
Child's Last Name
Child's Date of Birth
Number of seasons played

Would you like to:CoachAsst.CoachTeam Manager

Emergency Contact:
Relationship:
Phone:
List Allegies:
Doctor:
Doctor Phone:
Medical Conditions:

Insurance Company:
Policy Number:
Group Number:
Phone Number:
Do you have any friends you want to be on the same team with? (Not promised, Siblings of the same age will be on the same team) Comments:

PARENT'S APPROVAL AND MEDICAL RELEASE

Recognizing the possibility of physical injury associated with soccer and in consideration for the US Soccer/USYS and its
affiliates accepting the registrant for its soccer programs and activities (the "Programs"), I hereby release, discharge and/or
otherwise indemnify the US Soccer/USYS, 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 or on 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.
From time to time pictures will be take of games, practices, and individual players. I hereby agree that any photos
taken of my child may be used in advertising or media for the promotion of Hueytown Soccer Club, Inc.

Clicking "submit" I agree to the terms above.