Player's Name

First Name

Last Name

Birthdate *

MM

DD

YYYY

Preferred Phone Number *

(###)

###

####

Secondary Phone Number *

(###)

###

####

Parent/Legal Guardian Name *

I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Trinity UMC Soccer Program, it’s affiliated organization and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the Trinity UMC Soccer Program accepting the registrant for its soccer programs and activities (the “Programs”). I hereby release, discharge, and/or otherwise indemnify the Trinity UMC Soccer Program, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the Programs against any claim by or on behalf of the registrant as a result of the registrants’ participation in the Programs. I understand that Team Pictures and Action Shots may be placed on the Trinity/TLC Web Site or used for publicity without names of participants being published.

First Name

Last Name

Signature *

I have read and agree to the above statement and am aware that checking this box legally serves as my signature.

I agree.

Consent for Medical Treatment (Minor) *

As the parent/legal guardian of the registered player listed on the front of this page, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions necessary to preserve the life, limb or wellbeing of my dependent.

First Name

Last Name

Medical Consent Signature *

I have read and agree to the above statement and am aware that checking this box legally serves as my signature.

I agree.

Please check the area you would like to help with:

Coach

Assistant Coach

Field Set Up

Team Snack Coordinator

Volunteer Name

First Name

Last Name