All-Star Player Form

PISA All-Star Player Form

* Indicates required field

Player Information

Player Name *

First

Last

Age Division - Spring 2017 *

Jersey Size *

Recreation Team Name *

Date of Birth *

Parent/Guardian Information

Primary Parent/Guardian Name *

First

Last

Primary Phone Number *

Primary Email *

By clicking the Submit button below, you agree to have read the following Player Participation Agreement.

We/ I, as the parent/legal guardian of the player named above, do hereby declare our intent to allow this child to practice, play, and participate in all programs and activities associated with the Pleasure Island Soccer Association, including any related activities and transportation. We/ I hereby release and hold harmless from any and all liability; Pleasure Island Soccer Association, its coaches, sponsors, associated board members and personnel, officials, or any others associated with this organization against any claim by or on behalf of the player’s participation in this program.
We/ I do hereby authorize Pleasure Island Soccer Association or any representatives including coaches, officials, or anyone associated with this organization, if after reasonable attempt has been made to reach the designated parent/guardian named above to consent, or if sound medical practice decrees that there is not time to make such an attempt, to consent to any x-ray, anesthetic, medical or surgical diagnosis or treatment or hospital care, to be rendered to the player under the general or special supervision and on the advise of any physician, dentist or surgeon duly licensed to practice, be indeed rendered to the Registrant.

PISA All-Star Form