Mississippi Flood FC - Central 2017/18 Tryout Form

MS Flood FC - Central 2017/2018 Tryout Form
Player Name*

First NameLast Name
Sex*

MaleFemale
Age*
Birth date*

MonthDayYear
Playing Experience (Years)*
Previous Clubs*
Primary Position*
Secondary Position
Parent/Guardian Name(s)*
Main Contact Number*

Area CodePhone Number
E-mail*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Once tryouts are complete, the coach will notify:
Name*
Phone Number*

Area CodePhone Number
If your child accepts an offer, would you be interested in having a role as manager, treasurer, scheduler, etc.?

YesNo
Medical Treatment Authorization and Liability Waiver
Please read and sign at the bottom. You may use your mouse or trackpad to do this on a computer. Use your finger or stylus on a mobile device.

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify MS Flood FC, MS Flood FC Central, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of their organization, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in the US Cub Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.
I agree to these terms and conditions*

Check To Agree
Signature*

Clear
Should be Empty:

MS Flood FC - Central 2017/2018 Tryout Form

Once tryouts are complete, the coach will notify:

Medical Treatment Authorization and Liability Waiver