E-mail Address: *
Players Name *
Age *
DOB *
Under *9
10
11
12
13
14
15
16
17
18
Gender *Male
Female
Players Grade Fall 2008 *
Parent/Guardians Name *
Parent/Guardians Phone *
Parent/Guardians Cell *
Parent/Guardians Email *
Address *
City *
State *
Zip *
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact Cell
Medical/Legal AuthorizationMedical/Legal Authorization:
I, the legal guardian of the above applicant authorize the Falcons Futbol Club personnel to request medical treatment as necessary to insure the safety and well being of my dependent. I know of no medical or other reason why applicant cannot participate in soccer activities. I hereby waive Falcons Futbol Club and their personnel against any and all liability, judgments, or demands for damages arising as a result of injuries sustained during the applicant’s participation in Tryout activities. I understand and accept the potential for injury and our child participates at his/her own risk. I agree to pay for any property damage my dependent may cause during their stay.
I Agree to the Medical/Legal Authorization *
Parent Gaurdian Signature (Type Name) *
Date *
* Required