Florida Soccer Club Player Registration Form

Florida Soccer Club/Temple Terrace Soccer Association
Player Registration Form

Fill out this form and your application will be sent. Once you have sent your application, you must mail your payment in.

Player Name

Last:

First:

Initial:

Phones

Home:

Work:

Mobile:

Address


City:
Zip:

Gender

Birth Date


Verif.
HS Grad Year:
Citizen	Yes No

Email Address

Parent/Guardian Name(s)

(seperate by commas)

Informed Consent/Insurance Notice

FYSA RECOMMENDS THAT PLAYERS NOT REGISTER TO A TEAM WHOSE AGE GROUP EXCEEDS THE PLAYER'S NORMAL AGE.

INSURANCE NOTICE: All injuries must be reported within 90 days of the date of the injury

INFORMED CONSENT: I, the parent/guardian of the registrant, agree that we will abide by the rules of FSC/TTSA, the state association (FYSA) and all its affiliated organizations. My/our child wishes to participate in soccer during the season of this registration. I/we reali ze riskes are involved in my/our child's participation. I/we understand that the risk to my/our child includes full range of injuries from minor to severe, and the result could be death, paralysis, or other seriout, permanent disabuility. I/we accept this risk as a condition of my/our child's participation. i give permission for representatives of FSC/TTSA to secure medical treatment for my child in the event the parents cannot be contacted and such treatment is deemed necesarry. There will be NO REFUNDS.

I DO NOT give TTSA permission to use photos of my child on their website.

Parent/Guardian Authorization