Tryout Registration & Evaluation Form
Personal Information Participant Name: ____________________________ Age: __________ DOB: ___________ Address: ______________________________________________________________ City: _______________________________ State: _________ Zip Code : _________ Home Phone: ________________________ Mobile Phone: ______________________ Email Address: ___________________________________ In case of emergency, please notify: Name:_____________________________ Phone Number: _______________________ Release and Liability Waiver: In recognition of, and with knowledge of, the fact that engaging in the sport/activity of SOCCER could involve substantial risk of personal injury, I, the undersigned, warrant that I am in good physical condition and hereby agree to assume the risk of any injury I may suffer as a result of my participation in try-outs for Pelham Soccer Club. Therefore, in consideration for being permitted to participate in such try-outs, I hereby release, waive, and forever discharge Pelham Soccer Club, Pelham Parks and Recreation, Coaches and the PSC volunteers from any and every claim, demand or actions of whatever kind, arising from any bodily harm, personal injury or death resulting from any accident which may occur as a result of participation in these try-outs. Further, and to the same extent and scope, I release said parties from any claim whatsoever which may be attributable to the receipt of first aid or other emergency treatment rendered me in connection with my participation in such try-outs. I understand that PSC will not provide any assistance with any medical bill(s) associated with my try-out or participation with a PSC team should I be injured.
Participant’s Name: ___________________________________ Parent Signature : _____________________________________ Date: __________________ Photo/Video Release _____Pelham Soccer Club has my permission to publish my or my child’s photograph in the media to promote the PSC. _____ PSC has my permission to use my or my child’s photograph or video on the PSC website or the PSC Facebook Page.
Parent Signature: ______________________________________ Date: ___________________ OFFICE USE ONLY
Player ratings for each criteria will range from 1 (Developing) to 5 (Advanced), with a score of 3 representing an at-level (Competent) rating for the age group.