Registration Forms

*** Please start by selecting the proper form from the pulldown list. ***


Player Information:


first

middle

Last

 

Player Status

 


Shirt Size:

YM

YL

AS

AM

AL

AXL


Age:

Birthday

       

Parent/Guardian Information

First

middle

Last

       
       

Street

City

State

Zip

 
 

Phone (Day)       (Evening)       (Cell)   

Email   


Insurance

All injuries must be reported within 90 days of the date of injury. Benefits will be provided for eligible
expenses not paid by other insurance health plans after the FYSA deductible has been satisfied.

Do you have health insurance?

         

Informed Consent

I, the parent/guardian of the registrant, acknowledge that I am completely aware of the inherent risks associated with soccer, ad hereby waive, release, and discharge the state association (FYSA) and all of its affiliated organizations, as well as their officers, directors, employees and agents (collectively, the "Released Parties"), from any and all liability and responsibility in the event that my minor child, (child's name) becomes injured in any way during their participation in soccer events or activities associated with the Released Parties. I further state that I and/or my child takes full responsibility for any injury that may occur as a result of my child's participation, and that neither I nor my child will hold the Released Parties responsible for any aggravation of pre-existing injuries prior to or during my child's participation in any soccer events or activities associated with the Released Parties.

Accept

yes

no

   

 

 
"Palm Beach Soccer Academy, Bringing the highest level of professional soccer training to the youth of Palm Beach County"
Mission Statement Club History Club Services Club Try-Out Policy Affiliations & Certifications Ethics
Management Board Coaching Staff International Coaching Operational Structure Contact
Boys Under 10 WhiteBoys Under 9 RedBoys Under 9 BlueGirls Under 11Boys Under 10Girls Under 12Boys Under 11 Boys Under 12 WhiteBoys Under 12 Red Boys Under 14
Burns RoadMirasolPGA National Park
Players Coaches & Volunteers Parents & Spectators