Player Information Sex M F (Choose One) Birth Date (MM/DD/YYYY)

First Middle Init. Last

Address

City State Zip

Main Phone # (555 555-5555)

Uniform Size (Click one for each)

Shirt YM YL AS AM AL AXL Parents email

Short YM YL AS AM AL AXL Players email (Optional)

Check the Position or Positions Desired (Click All That Apply)

Goalie Defender Midfielder Forward

(The coach will determine final positions)

Will you be playing another sport in the Fall/Spring? No Yes

What Sport?

Medical Concerns (Please any medical conditions that the coach should be aware of)

Parental Information

Fathers First Name Fathers Last Name

Home Phone Cell Phone

Mothers First Name Mothers Last Name

Home Phone Cell Phone

Please help support our club. Please check something you are willing to help with. (Coaches can answer any Questions)

Parent Representative Newsletter SAGE Rep Sideline Flag

Do you have a coaching license? YES NO

Are you willing to coach or assist? YES NO

If yes what level? F E D C B A

Name of person with license?

How did you hear about these tryouts?

School Flier Word of mouth Newspaper Roadside Sign Movie Theater Channel 21

Online Web Search Attended A Warren United game Poster in Store Already on Team Other

RELEASE This release is made to allow my/our child to participate in the Warren United Soccer Club Team Tryouts and recognize that my/our signature on this release is a condition of our permitting my/our child to participate. I/We certify that my/our child is in excellent physical health, there are no physical limitations to my/our child to participate in this program, may participate in strenuous and hazardous physical activities, and grant permission for my/our child to receive emergency medical treatment if needed. I/We herby release and discharge Warren United Soccer Club, Washington Twp. Washington Boro, Mansfield Twp, Franklin Twp., White Twp., club evaluators, volunteers, coaches, and all their affiliated entities from any and all liability, claims, demands, and causes of action for personal injury, property damage and/or other loss suffered by my/our child in connection with his/her participation in this program. I/WE represent that I am/We are the parents/guardians of the minor named above, and I/We agree that the grant and releases contained therein binds me/us and the minor to all of its terms.

Parent Name (Please Fill in Parent Name only if you agree to the release above. Failing to sign below will result in your child not participating in Warren United Tryouts)

Parent/Guardian Agree Date