Player First Name   Player Last Name    
 Date of Birth    Gender
 Parent First Name    Parent Last Name  
 Player School    Grade  
Current Team    Medical Conditions  
 Emergency Contact  
Please give us an idea of which of our events you would like to paticipate in


Annual
Fall
Winter
Spring
Address Line 1   Address Line 2  
Country   State  
City   Zip  
Phone Number  
Mobile 1   Mobile 2  
Email 1   Email 2  
Can Parent Help Manage Team Can Parent Help Recruit

LIABILITY RELEASE: I, the parent/guardian of the above named “Player”, a minor, agree that the Player and I will abide by the rules of the HP Soccer Academy (“Academy”), its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the Academy accepting the Player for its soccer programs and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify the Academy, its affiliated organizations and sponsors, their employees, associated personnel and volunteers as a result of the Player’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. I further grant the Academy the right to use my electronic signature, the player’s name, pictures and /or likeness in printed, broadcast,  and other material concerning the Programs provided such use is related to the Player’s status as a participant in the Programs.

CONSENT FOR MEDICAL TREATMENT (MINOR) 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 are necessary to preserve the life, limb or well-being of my dependent.

Consent for Medical Treatment
and Liabiity release
  Approving Parent Name