Registration Form

Please be sure all information is accurate

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* 1. Site

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* 2. New Player?/Jugador Nuevo?

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* 3. Player First Name/Nombre de Jugador

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* 4. Player Last Name/Apellido de Jugador

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* 5. Date of Birth/Fecha de Nacimiento (MM/DD/YYYY)

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* 6. Describe Previous playing experience/Describe Experencia de futbol previo

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* 7. Gender/Sexo

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* 8. Ethnicity/Ethnica

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* 9. Jersey Size

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* 10. Shorts Size

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* 11. Socks Size

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* 12. In the past 24 hrs as your player experienced any of the following symptoms? (Check all that apply)/En las ultimas 24 horas su jugador(a) a sentido alguno(as) de las siguientes sintomas? (seleccione todo lo que aplique)

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* 13. Parent/Guardian Information
Información de Padre(s)

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* 14. Relationship to Child
Relación al niño(a)

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* 15. Emergency Contact (Other than Parent/Guardian) 
Contacto en caso de Emergencia (Otro que no sea Padre/Tutor Legal)

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* 16. I, the undersigned, understand that participation in the Houston Parks and Recreation Department's (HPARD) H-Town Soccer Academy involves certain inherent risks of injury, despite all safety precautions taken by the HPARD. Therefore, as parent and/or guardian, I will assume all risks, injury or illness, for my child(ren) that may occur during the participation in any activities or use of facilities associated with the H-Town Soccer Academy. In the event that my child(ren) need medical treatment due to accident or injury or natural causes while registered and participating in the H-Town Soccer Academy program, I authorize the HPARD staff and operators to take whatever action is necessary to care for my child(ren). I hereby give permission for the HPARD staff to use their best judgment in arranging for my child(ren)’s emergency medical treatment in addition to contacting me to the best of their ability. I certify that my child(ren) is/are fully covered by medical insurance and that I am fully responsible for all costs incurred due to medical or dental treatment as deemed necessary by the HPARD staff and operators.

By signing this form, I acknowledge that I am aware of the potential risks of participation in any activities or use of facilities associated with the H-Town Soccer Academy program, and in no way hold the HPARD, its respective parent, its subsidiaries or affiliates, or their respective management, agents, employees, directors, officers, sponsoring agencies, volunteers or the facility or its operators, coaches, officials, or advertisers, (individually and collectively, the "released parties"), liable for any injury that my child(ren) may sustain. I, FOR MYSELF, MY SPOUSE AND MY CHILD(REN), DO FURTHER RELEASE, ABSOLVE, INDEMNIFY, AND HOLD THE RELEASED PARTIES HARMLESS AGAINST ANY CLAIMS OF INJURY OR DEATH TO MY CHILD(REN) IN CONNECTION WITH ANY AND ALL OF THE ACTIVITIES MENTIONED.

I HAVE READ, AND I UNDERSTAND, AND I VOLUNTARILY SIGN THIS MEDICAL RELEASE/WAIVER/INDEMNITY AGREEMENT.

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* 17. Parent/Legal Guardian Signature
Firma de Padre

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