The Shooting Stars FC Registration Form - Become a Star!

Player Registration:

Current Team: (if any)
Age / Gender:   Age/Group:   Gender:  
Grade:   Age:    Birth Date
City, State Zip: ,  
Home Phone:

Parent  Information:

Father's Name:
Father's Email:
Work Phone:
Cell Phone:
 Mother's Name:
Mother's Email:
Work Phone:
Cell Phone:

Emergency Contact Information:

Contact Name:
Cell Phone:

Medical Conditions:

Known Allergies:
Medical Conditions:

Consent & Release Section:

Consent for Emergency Medical Aid and Medical Treatment
As the registrant or Parent/Legal Guardian of the above named registrant, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dental Medicine. This care may be given under whatever conditions are necessary to preserve life, limb, or well-being as deemed advisable in the event of an accident or illness during the soccer related activities in which we are voluntarily participating.  I , the participant or parent/guardian of a minor registrant, agree that the registrant and I will abide by the rules of the league, its affiliates and sponsors. Recognizing the possibility of physical injury associated with Futsal and in consideration for the Club accepting the registrant for its Futsal  programs and activities (the "Programs"), I hereby release, discharge, and/or indemnify the club, its affiliated organizations (if any) and sponsors, their employees and associated personnel, including the owners of gymnasiums and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. Further, I hereby acknowledge that participation in athletic competitions, camps, and/or clinics carries with it certain potential hazards. In consideration for the Club accepting the registrant for its program,  I further release, discharge and/or indemnify the Club, its officers, directors and employees, any coaches, assistant coaches and referees, the facilities in which any such athletic activities are being physically conducted, the leagues with which the Club is affiliated, the organization permitting the institution/facility, and the institution/facility at which this activity is being conducted, against any claim by or on behalf of the registrant as a result of registrant's participation in the Futsal programs.

Parent / Legal Guardian Name:
Parent / Legal Guardian Signature:  
(if signing up online please type in name and last 4 digits of your social security number)



  2005 All Rights Reserved