Girls Soccer Program Registration

Player Name

Date Of Birth

Parent Guardian Name

Address

City

Postal Code

Phone

Program selection

1. PARTICIPATION AGREEMENT

I, The parent or legal guardian of the above-named participant, give permission for my child to participate in activities organized by Prime Youth Soccer, including but not limited to (Please Must click all checkboxes for permissions if you wish to continue, Otherwise application won't be accepted): Soccer training sessions League games Skills development programs Tournaments Soccer camps or clinics

2. ASSUMPTION OF RISK

I acknowledge that soccer activities may involve risks including but not limited to (Please Must click all checkboxes for permissions if you wish to continue, Otherwise application won't be accepted): Falls Collisions with players or equipment Sprains, fractures or injuries Weather-related conditions Field hazards

3. RELEASE OF LIABILITY

I hereby release, waive, and discharge Prime Youth Soccer, its (Please Must click all checkboxes for permissions if you wish to continue, Otherwise application won't be accepted): Directors Coaches Volunteers Staff members Facility providers

4. MEDICAL AUTHORIZATION

In the event of an emergency, I authorize Prime Youth Soccer staff to seek medical treatment for my child if I cannot be reached (Please Must click all checkboxes for permissions if you wish to continue, Otherwise application won't be accepted). I understand that all reasonable efforts will be made to contact me first.

Medical Conditions / Allergies (if any / If none, Please write none):

5. PHOTO & MEDIA CONSENT

I grant permission for Prime Youth Soccer to use photographs or video recordings for(Please Must click all checkboxes for permissions if you wish to continue, Otherwise application won't be accepted): League promotion Social media Website content Marketing materials

6. ACKNOWLEDGEMENT

7. Signature: Please Enter Your FULL NAME

8. Date

Instructions & Next Step

By submitting this form, you will be redirected to the Stripe Checkout page. Your email address will be pre-filled based on the information you provided in this form. Please do not change or modify the email address, as we use it to verify and confirm your payment. Any alteration may delay or invalidate payment confirmation. By proceeding, you acknowledge that you have read, understood, and agree to these instructions. Please select the checkbox below to confirm your consent before clicking the Submit button.

Girls Soccer Program Program Registration