Registration & Waiver | Premier Soccer Training

PARTICIPANT INFORMATION

Player Full Name

Birthday

Month

Day

Year

Gender

Parent/Guardian Full Name

Address

Phone

Email

Emergency Contact Name / Phone Number

MEDICAL INFORMATION AND EMERGENCY CONTACT

Does the player have any existing medical conditions (e.g., asthma, allergies, previous injuries)?

Yes

No

Does the player require any special medication during training or events?

Yes

No

Allergies (e.g., food, environmental)?

Yes

No

Primary Care Physician’s Name & Phone Number

GENERAL WAIVER AND RELEASE OF LIABILITY

I am the legal parent or guardian of the participant. By checking this box, I acknowledge the risks of participation and agree to release and hold harmless Premier Soccer Training from all liability related to participation.

CONSENT TO TRAVEL AND TRANSPORT

I am the legal parent or guardian of the participant and consent to transportation provided by Premier Soccer Training for off-site activities. I acknowledge the risks associated with transportation and agree to release and hold harmless Premier Soccer Training from liability related to such transportation.

CODE OF CONDUCT ACKNOWLEDGEMENT

I have read and understand the Code of Conduct for Premier Soccer Training and agree to ensure that my child complies with these guidelines. I acknowledge that violations may result in disciplinary action.

PHOTO AND VIDEO RELEASE

I am the legal parent or guardian of the participant and grant Premier Soccer Training permission to photograph, video record, and use my child’s image or voice for promotional purposes, including website and social media. I understand this media may be publicly displayed and that no compensation will be provided.

ACKNOWLEDGMENT OF RISK AND MEDICAL CONSENT

I acknowledge that participation in soccer training and related activities involves inherent risks of injury. I confirm that I have been informed of these risks and voluntarily allow my child to participate.

In the event of an injury or medical emergency, I authorize Premier Soccer Training and its staff to obtain emergency medical treatment for my child if I cannot be reached. I understand and agree that I am solely responsible for any medical expenses incurred as a result of such treatment.

INSURANCE AND HEALTH COVERAGE

I confirm that the player has health insurance coverage and that I am responsible for any medical expenses incurred due to an injury sustained during training or related activities.

Medical Insurance Provider & Policy Number

I agree to the Waiver & Release of Liability (click to view).

PARENT/GUARDIAN SIGNATURE

I am the legal parent or guardian of the participant. I acknowledge that I have read and understand all terms and conditions of this agreement, including the waiver of liability, assumption of risk, transportation consent, medical authorization, media release, and Code of Conduct.

I certify that the information provided is true, accurate, and complete to the best of my knowledge.

By submitting this form, I agree that my electronic signature is legally binding.

Player Birth Certificate

Parent/Guardian Full Name

Date picker

Signature

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Player Signature (if over 18)

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