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DEVELOPMENTAL
COMPETITIVE
Recorded Games
GAMEDAY
ABOUT
NEWS
SPONSORSHIPS
CONTACT
DONATE
PLAYER MEDICAL RELEASE FORM
PWYS
2020-07-31T17:10:39+00:00
Player Interest From
Player Information
Player's Name
(Required)
First
Last
Player's Phone
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Player's Email
(Required)
Player's School
(Required)
Soccer Position
(Required)
Goalkeeper
Right/Left Back
Center Back
Defensive Midfielder
Offensive Midfielder
Right/Left Winger
Striker
Not sure
Tell us your preferred position(s)
Have you played competitive soccer before?
(Required)
Yes
No
What team did you play for?
(Required)
How many years did you play?
(Required)
Which team do you want to join
(Required)
PWYS 06' Boys (born in 2006 & 2007)
PWYS 08' Boys (born in 2008 & 2009)
PWYS 10' Boys (born in 2010 & 2011)
PWYS '12 Boys (born in 2012 & under)
Parent Information
Parent's Name
(Required)
First
Last
Phone
Parent's Email
Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Waiver Consent
(Required)
I agree to the waiver policy.
Waiver: Recognizing the possibility of injury or illness, accepting my son(s)/daughter(s) as a player in this soccer program, I consent to my son(s)/daughter(s) participating in the Play Where You Stay soccer program. Further, I hereby release, discharge, and otherwise indemnify Play Where You Stay, its related entities, sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the program, against any claim by or on behalf of my player son(s)/daughter(s) as a result of my son(s)/daughter(s) participation in the program and/or being transported to or from the programs. I hereby authorize the transportation of my son(s)/daughter(s) to or from the program. I give my consent to have a coach and/or licensed medical doctor or dentist provide my son(s)/daughter(s) with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.
By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Photo Video Consent
I agree to the photo/video policy.
Play Where You Stay takes photographs/video of players and staff during practices and games for the purpose of promoting Play Where You Stay. The inclusion of your name below releases and discharges Play Where You Stay from any and all claims arising out of the use of photographs/video, or any right that the parent(s) or minor(s) may have.
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