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Open to Players born 2005-2016
ALL WEDNESDAY SESSIONS: MARCH, APRIL, MAY ($250)
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Indicates required field
(BE SURE ALL REQUIRED FIELDS ARE COMPLETED)
Player Information
Player
*
First
Last
Gender
*
Male
Female
Date of Birth
*
enter this format: MM/DD/YYYY
Grade
*
-
1
2
3
4
5
6
7
8
9
10
11
12
Street
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City
*
Wilmington
Carolina Beach
Kure Beach
Wrightsville Beach
Leland
Shallotte
Southport
Other
Zip Code
*
28401
28403
28405
28409
28412
28428
28449
28451
28459
28461
28470
28479
other
Parent/Guardian Information
Parent
*
First
Last
Cell Phone
*
Primary Email
*
Email will be used as primary communication. Make sure address is typed correctly.
2nd Email
*
Player Participation & Payment Agreement - Liability Waiver
I/we 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.
By clicking the Submit button below, you agree to have read the Player Participation Agreement.
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YES - I Agree to the terms
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