WINTER

REGISTRATION

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Winter Registration

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthday

Month

Day

Year

Current School & Grade

Parent / Guardian Name

Select Appropriate Title

Parent

Guardian

Phone

List any problems or prohibition coaches should be aware of:

List any allergies coaches should be aware of:

Emergency Contact Name

Emergency Contact Phone

IMPORTANT WAIVER. I, the Parent or Guardian of the registrant, a minor. Agree that I will abide by the rules of the Young Stars Youth Academy FC. In recognition of, and with knowledge of the fact that engaging in the sport of soccer could involve substantial risk of personal injury. I, the undersigned, warrants that my child/children are in good physical condition and hereby agrees to assume the risk of any injury he/she may suffer as a result of his/her participation in the sport at Young Stars

Signature

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Date

Month

Day

Year