Soccer Registration

The Feliz Soccer program is open to both boys and girls between 6 and 12. View soccer posts and info »

I hereby enroll in Street Soccer USA:(Required)

(youth participant’s name)

Gender:(Required)

Male

Female

Birth Date:(Required)

Child's Ethnicity:(Required)

Ethnicity "Other":

Grade(Required)

School

List known medical concerns/allergies:

Does your child have permission to walk/bicycle/take public transportation home alone?(Required)

Yes

He/she will be picked up in person by:

Person/s allowed to pick up the child:(Required)

Your name (parent/guardian):(Required)

Preferred method of communication?(Required)

Your phone number/s:

Your email:

Home address:(Required)

Street Address City State ZIP / Postal Code

Emergency Contact Name:(Required)

First Last

Emergency Contact Phone Number:(Required)

Today's date:(Required)

WAIVER / INDEMNIFICATION

Parent(s) or legal guardian must sign below before player is accepted to participate in the Street Soccer USA program: As parent/legal guardian of the child named herein, I hereby represent that the child has been examined by a pediatrician and is physically fit to participate in the Street Soccer USA program. I understand there are inherent risks to participating in this athletic program. I hereby accept responsibility for and agree to pay any and all costs of medical treatment resulting from any injury suffered by my child as a result of his/her participation at Street Soccer USA. I further agree to indemnify and hold harmless Street Soccer USA from any and all liability, damage, or expense arising out of my child’s participation at Street Soccer USA program.

In the event that I cannot be reached in an emergency, I hereby give permission for a qualified Street Soccer USA staff member, an emergency medical technician, a physician or staff member at a hospital, or any other qualified individual to administer care and provide any medical treatment deemed necessary for my child.

Waiver/indemnification(Required)

I ACCEPT THE WAIVER / INDEMNIFICATION ABOVE

MONITORING AND EVALUATION PARENTAL CONSENT

I give permission for Street Soccer USA staff/affiliates to collect and record data in the form of surveys and fitness measurements about my child with the understanding that all information obtained will remain private and that any responses publicly reported will be grouped together with other participants of this program and that my child will not be individually linked to her/his response. I understand that results of such data collection will not be used as a determinant to my child’s participation in Street Soccer USA; rather, results from such data collection will be used by Street Soccer USA to better understand the needs of participants in the program as well as for the overall improvement of Street Soccer USA.

Monitoring(Required)

I CONSENT TO THE MONITORING CONSENT ABOVE

MEDIA RELEASE FORM

I grant permission for my child to be filmed or recorded during Street Soccer USA programs, special events and media coverage. I waive all rights in any film or recording made thereof. I hereby grant Street Soccer USA and its affiliates perpetual and irrevocable right to use my child's picture, portrait, or photograph for all purposes and in all media including advertising, trade, promotion, exhibition, grant proposal, or any other lawful purposes and hereby release and agree to hold harmless Street Soccer USA and its affiliates from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form in the recording or processing of the photographs, films and/or videos toward the completion of the finished product. I hereby waive any claims I may have based on any usage of the photographs, films, and/or videos or works derived therefrom.

Media Consent(Required)

I CONSENT TO THE MEDIA RELEASE FORM ABOVE