Youth Soccer Registration Form

Just For Kicks Registration Form

To register for Soccer, just fill out the short form below and click the "Submit" link.

Player's Last/First Name*
Home Address - Street, City, ST, Zip*
Phone Number*	Gender*	Age (as of 6/1)*
Grade Entering This Fall*		T-shirt size:*
Father's name*		Father's Cell
Mother's Name*		Mother's Cell
Parent Email Address
Emergency contact - if parents cannot be reached*		Emergency Phone*
known medical conditions Please be specific

Release of Liability/Hold Harmless Agreement
The undersigned Parent / Guardian, in consideration of acceptance of this child as a participant in this activity sponsored by Westerville Christian Church (WCC) does hereby: (1) agree to assume any and all risks and liabilities incidental to the child’s participation; (2) agree that all known medical/health conditions have been disclosed to WCC on this form; (3) acknowledge that no medical insurance is maintained by WCC; such insurance being the sole responsibility of each participant family; and (4) agree to indemnify, defend and hold WCC, their Trustees, Staff, Elders, Coaches and Officials harmless from and against any claim or demand, and from liability for any injury or property damage.
	YesNo


* Required