2014 Tryouts Registration


Save the Dates: Pre-Tryout Drop-in Clinincs and Tryouts - Click Here

  

 2014-2015 Age Matrix 
U8 8/1/06 - 7/31/08
U9 8/1/05 - 7/31/06
U10 8/1/04 - 7/31/05
U11 8/1/03 - 7/31/04
U12 8/1/02 - 7/31/03
U13 8/1/01 - 7/31/02
U14 8/1/00 - 7/31/01
U15 8/1/99 - 7/31/00
U16 8/1/98 - 7/31/99
U17 8/1/97 - 7/31/98
U18 8/1/96 - 7/31/97
       .........
 Player Information
 
    Player Name on Birth Certificate:
      First Name: Middle: Last:  
      Nick-Name: 
   ...............................................................................................................................
    Player's Email Address:  
    Player's Cell Phone:  
 
    Date of Birth: ,  
    Play-up Request: Yes     No
    Gender: Boy     Girl
   
    Position(s) of Interest:  Forward    Midfield    Defender    Goal Keeper
    Current Club:  
    Current Team Name:  
   
    Residential Address:
    City:˚     State:    Zip:
 
    School Name (this year)        Grade:
    School Name (next year)
   ...............................................  
 Parent/Guardian Contact Information
 
Parent/Guardian 1      
    First Name:

Last Name:   

    Relationship:     
    
    Primary Email Address:
    Verify Primary Email:
    Secondary Email:
      
    Primary Phone:

    Secondary Phone:   

 
    Mailing Address:    Same as Player
       Street: 
       City:    State:   Zip:
 
Parent/Guardian 2      
    First Name:

Last Name:  

    Relationship:     
    
    Primary Email Address:
    Verify Primary Email:
    Secondary Email:
      
    Primary Phone:

    Secondary Phone:  

 
    Mailing Address:   Same as Player
       Street: 
       City:    State:   Zip:
     
 Emergency Information
Emergency Contact Name:
Emergency Contact Phone:  
Doctor Name:
Doctor Phone:
 
 Anti-Spam
   
Type the characters you see in the image above:  
  
 Parent/Guardian Waiver

By submitting this form, I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the US Club Soccer, its affiliated organization and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the US Club Soccer accepting the registrant for its soccer program and activities ("The program"), I hereby release, discharge and otherwise indemnify the US Club Soccer, its affiliated organizations and others, their employees and associated personnel, including the owners of the fields and facilities utilized for the program against any claims by or on behalf of the registrant as a result of the registrant's participation in the program and/or being transported to or from the game, which transportation I hereby authorize.

Visual Consent

I give Placer United Soccer Club and any photographer hired by them, permission to make photographs, videotapes, films, slideshows, or other likenesses of my child or legal ward. I hereby grant Placer United Soccer Club and any photographer hired by them, the unrestricted right to copyright any of the above-mentioned materials containing images of me, my child or legal ward, as well as the unrestricted right to use and reuse them, with or without caption information, in part or in whole, in any manor, for any purpose and in any medium now known of hereinafter invented. These rights include, but are not limited to, the right to publish copy, distribute, alter, license and publicly display these materials and images for editorial, trade, marketing and/or advertising purposes. I also grant Placer United Soccer Club and any photographer hired by them, and its licensees the unrestricted right to use and disclose my name in connection with the use of the above materials.

I understand and I agree I will not be paid for any of the described above.

I also waive, and release and discharge, Placer United Soccer Club and any photographer hired by them, any and all claims arising out of or in connection with any use of the materials, caption information and images above, including any and all claims for libel, defamation and/or invasion of privacy or publicity. I realize I cannot withdraw my consent after I sign this form and I realize this form is binding on me and my heirs, legal representatives and assigns.
 

 

If you experience any problems with this form, please contact support@placerunited.com

 

 

 





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1091 Tinker Rd., Suite 300, Rocklin, CA 95765 | (916) 434-5890 | info@placerunited.com
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