Player Name *

First Name

Last Name

DOB *

Date of Birth

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father's Name

First Name

Last Name

Father's Phone

(###)

###

####

Father's Work Phone

(###)

###

####

Mother's Name

First Name

Last Name

Mother's Phone

(###)

###

####

Mother's Work Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Emergency Contact 2 Name

First Name

Last Name

Emergency Contact 2 Phone

(###)

###

####

Acknowledgement *

PARENT/GUARDIAN CONSENT AND MEDICAL RELEASE Recognizing the possibility of injury or illness, and in consideration for Forms Academy, AlphaForms, and DinoScores and members of Forms Academy, AlphaForms, and/or DinoScores accepting my son/daughter as a player in the soccer programs and activities of Forms Academy, AlphaForms, and/or DinoScores and its members (the “Programs”), I consent to my son/daughter participating in the Programs. Further, I hereby release, discharge, and otherwise indemnify Forms Academy, AlphaForms, and DinoScores, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my player son/daughter as a result of my son’s/daughter’s participation in the Programs or trainings sessions. I confirm that my son/daughter is physically capable of participating in the sport of soccer. I have provided written notice, which is submitted in conjunction with this release and attached hereto, setting forth any specific issue, condition, or ailment, in addition to what is specified above, that my child has or that may impact my child’s participation in the Programs. I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.

I understand, agree to, and consent to the above.