Encinitas Express 2012 Tryouts Registration

Encinitas Express Soccer

2012 TRYOUTS

Player First Name: *

Last Name: *

DOB: *

Prior Team:

Position:

Parent First Name: *

Parent Last Name: *

Home Phone: *

Cell Phone:

E-mail Address: *

Player Shirt Size: *

Will You Need Financial Aid?: *

Eligible for qualified families. Proof required at the time of check-in.

IMPORTANT: *

By Submitting and/or printing and signing, you agree to the following: I/We, the parent/guardian of the above named player, a minor, and the above named player agree to the following: I hereby release, discharge and/or otherwise indemnify Encinitas Express soccer and its associated personnel, including the Board of Directors, Coaching Staff, League Administrators, and the owners of the fields and facilities utilized by Encinitas Express, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Encinitas Express tryout. In the event of an emergency or non-emergency situation requiring medical treatment, I hereby grant permission for any and all medical and/or dental attention to be administered to my child/children, in the even of an accidental injury or illness, until such time as I can be contacted. This permission includes, but is not limited to, the administration of first aid, the use of an ambulance, and the administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel.

Parent Signature:

Sign after you submit and print.

Today's Date: *

Encinitas Express 2012 Tryouts Registration

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