Pleasure Island Soccer Association PO Box 1868, Carolina Beach, NC 28428
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Rec/Hurricanes-Fall 2019
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Indoor Online Registration Form -
Deadline Dec. 5
Team & Coach Information
*
Indicates required field
Team Name
*
Male or Female
*
Male
Female
No Co-gender divisions
Age Group
*
U7
U8
U9
U10
U11
U12
2 age groups may be combined by tournament committee to form at least 4 teams/group
Coach/Primary Contact Name
*
First
Last
Primary Phone Number
*
Primary Email
*
Player Information
Players may not play-up more than one age division since divisions may be combined based on # of teams
Player #1 Name
*
First
Last
Date of Birth
*
MM-DD-YYYY
Parent Email
*
Player #2 Name
*
First
Last
Date of Birth
*
Email
*
Player #3 Name
*
First
Last
Date of Birth
*
Parent Email
*
Player #4 Name
*
First
Last
Date of Birth
*
Parent Email
*
Player #5 Name
*
First
Last
Date of Birth
*
Parent Email
*
Player #6 Name
*
First
Last
Date of Birth
*
Parent Email
*
By clicking the Submit button below, you agree to have read the following Liability Waiver & Medical Consent. You will then be directed to the online payment page to complete the team registration process.
As the team representative, I/we, as the parent/legal guardians of the players named above, do hereby declare our intent to allow each player to participate in the WAC Holiday Indoor soccer tournament. We/ I hereby release and hold harmless from any and all liability; Wilmington Athletic Club, Pleasure Island Soccer Association, their 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 event.
We/ I do hereby authorize Wilmington Athletic Club, 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. By clicking the Submit button below, you agree to have read the following Liability Waiver & Medical Consent. Then go to the online payment page to complete the registration process.
Submit Team Registration Form