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PISA All-Star
Player Form - Spring 2022
*
Indicates required field
Player Information
Player Name
*
First
Last
current grade
*
Select CURRENT GRADE not team division
BOYS - 5-6th Grade
BOYS - 4th Grade
BOYS - 3rd Grade
BOYS - 2nd Grade
BOYS - 1st Grade
GIRLS - 5-6th Grade
GIRLS - 4th Grade
GIRLS - 3rd Grade
GIRLS - 2nd Grade
GIRLS - 1st Grade
Click on the division you played this past Spring 2016
Jersey Size
*
Select Jersey Size
YS
YM
YL
AS
AM
Recreation Team Name
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Date of Birth
*
enter this format: MM/DD/YYYY
Parent/Guardian Information
Primary Parent/Guardian Name
*
First
Last
Primary Phone Number
*
Primary Email
*
Email will be used as primary communication. Make sure address is typed correctly.
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