Sign Up - Freeport Socccer Club

Player Info

Player First Name*

Player Last Name

Player Birthdate*

Player Gender*

Male
Female

Player Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Team*

Upload Copy of Birth Certificate*

Upload Picture of Player*

Upload Copy of Front of Insurance Card*

Upload Copy of Back of Insurance Card*

Does the participant have any health restrictions/problems of which FSC should be aware?*

No
Yes

Please Explain

Is the participant currently on medication?*

No
Yes

What medication and for what?

Previous Soccer Experience

Participant Agreement and Liability Releaase

I give my son/daughter permission to play on a traveling team for the Freeport Soccer Club. I know that soccer is a contact sport involving the risk of injury, and that my/our child runs the risk of being injured through his/her participation. I/We fully and voluntarily release the Freeport Soccer Club, its board members, coaches and team managers from any and all liability for claims arising from personal injury or property loss incurred by us or our child in preparation for, transportation to and from, or participation in any game or practice of the Freeport Soccer Club. This release is governed by and is to be interpreted under the laws of the state of Illinois, and it is intended as a full release and discharge of the Freeport Soccer Club, its board members, coaches and team managers only, and is invalid against any third party not affiliated with the club.It is understood that the Freeport Soccer Club does not provide medical or health insurance for the participants other than a supplementary and secondary group insurance provided by the Illinois Youth Soccer Association through the Clubs affiliation with IYSA and ILLOWA Soccer League, and that I, as the parent of the participating child am responsible for his/her insurance coverage.The Freeport Soccer Club reserves the exclusive right to establish and modify standards of conduct, behavior and performance for the players and parents in the program, and to require the players and parents to perform in strict compliance with these standards as a condition for continued participation in the Club. If the Club determines in the exercise of its sole discretion that further participation of the player or his/her parents in the program is inconsistent with the best interest of either the player, his or her parents or the Club, then the Club shall have the right to terminate the player’s participation in the program.

Authorize Agreement and Liability Release*

I Agree to above agreement and release

Publicity Photo Release

On occasion, Freeport Soccer Club (FSC) may have reason to publish in the local newspapers, on our website, or in publicity material for FSC, names and/or pictures of members of FSC. Pictures of their accomplishments or pictures of their participation in FSC related events may also be included.If you agree to have your child’s picture and name included in these publications, please indicate your consent by signing below. This agreement is in effect as long as your child is a member of the Freeport Soccer Club.

Authorize Release*

I agree to above release

Parent/Guardian Info

Mother/Guardian First Name*

Mother/Guardian Last Name*

Mother/Guardian Home Phone*

Mother/Guardian Cell Phone

Mother/Guardian Email*

Father/Guardian First Name*

Father/Guardian Last Name*

Father/Guardian Home Phone*

Father/Guardian Cell Phone

Father/Guardian Email*

Date

Would you like to support your team?*

Team Manager
Coach
Asst. Coach
No

Name of Person Interested*

Would you like to support the Club as a Committee Member?*

Yes
No

Name of Person Interested*

Signature

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New Player Registration Requirements

Player Info

Participant Agreement and Liability Releaase

Publicity Photo Release

Other Documents

Parent/Guardian Info