My Soccer Academy kissimmee Orlando Soccer Academy

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					                                My Soccer Academy
                                Kissimmee and Orlando FL.
                                phone: 407-223-8342
                                e-mail: coach@mysocceracademy.com




                            Cover Sheet for Academy Players
                               ***OFFICIAL USE ONLY – DO NOT FILL OUT***


     Bring a Buddy Referrals (-$10 per registered buddy) - ________
     {Buddies are new, registered players}



     Names of Referred Players:

      Name of Referred Player            Parent’s Name                   Parent’s Telephone

1.

2.

3.

4.




     Forms for Player’s File:

            •   This page
            •   Registration form + Medical release form
            •   Copy of Proof of age certificates or Birth Certificate
            •   Code of Conduct



     FEES Payable To: My Soccer Academy



     My Soccer Academy Player’s Information:

     Last Name:                                       First Name:
                                                                                                                    Player Registration #:
                                                                                                                    OFFICIAL USE ONLY




                                                       Academy Player                                                 My Soccer Academy
                                                     REGISTRATION FORM                                                in Kissimmee & Orlando FL.
                                                                                                                     www.MySoccerAcademy.com


 Player Last Name:                                                                    Player First Name:

 Street Address:                                                                      City:

 Zip Code:                                       Phone #:                             DOB:                          Age:                               Sex:

 Father’s Name:                                         Phone #:                                     Email:

 Mother’s Name:                                         Phone#:                                      Email:

 Person of Emergency:                                                             Doctor and Phone:

 Medical Problems? :


                                                                            IMPORTANT
I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of MSA, its affiliated organizations and sponsors. Recognizing the
possibility of physical injury associated with soccer and in consideration for MSA accepting the registrant for its soccer programs and activities (Programs). I hereby
release, discharge and/or otherwise indemnify MSA, its affiliated organizations and sponsors, their employees and associated personnel, including the registrant as a
result of the registrant, participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. I further grant MSA
Parties the right to use the player’s name, pictures and /or likeness in printed, broadcast and other material concerning the Programs provided such use is related to the
player’s status as a participant in the Programs.


Name: ________________________________________ Signature: X                                                                                Date: _________________
        Parent / Legal Guardian (please print)

                                                                MEDICAL RELEASE (MINOR)
I give permission for my child, to participate in MSA. I assume all risks and hazards incidental to such participation, and hereby release the Academy and its
employees and agents from any and all liability arising from injury or injuries sustained by my child while participating in the academy and its activities. I also
authorize the Academy to make decisions regarding and/or obtaining medical care for injuries and illness that affect my child. I further direct all medical or hospital
facilities to accept this document as authorization to render emergency care to my child should it be deemed medically necessary. Responsibility for primary medical
insurance coverage rests with the participant.


Signature of Parent / Legal Guardian: X___________________________________________

Address: ________________________________________________ City: ___________________________ State: ________ Zip Code:
__________

Phone #: __________________________________ Alternate Phone #: __________________________________

                 OFFICIAL USE ONLY                                                                    OFFICIAL USE ONLY
                                                                                                                                                Date:_____________
 DONATION: $ ________________                                       Home Association: MY SOCCER ACADEMY
                                                                    Registrar’s Phone #: 407-223-8342
 1. Cash: _______ 2. Check #: _____________                         Registrar’s Email: coach@mysocceracademy.com
 3. Credit Card #: _________________________                        Registrar’s Signature:
    Exp: ____________ CVV: ______________
                               My Soccer Academy
                               Kissimmee and Orlando FL.
                               phone: 407-223-8342
                               e-mail: coach@mysocceracademy.com




                                   Player • Parent • Staff
                                    Code of Conduct
Youth Sports play an important role in promoting the physical, social, and emotional development of
young people who can recognize choices, think about consequences and base their actions on that
information. Therefore, it is essential for parents, coaches, spectators, and officials to encourage youth
athletes to embrace the values of good sportsmanship. Furthermore, parents, coaches, spectators, and
officials involved in youth sports events should be models of good sportsmanship and should lead by
example by demonstrating fairness, respect, and self-control. My Soccer Academy is committed to
establishing an environment that is safe and fosters optimal learning opportunities for all
our players.

My Soccer Academy has formulated this Code of Conduct and requires that you commit to be responsible
for your words and actions while attending, coaching, officiating, or participating in My Soccer Academy’s
events and that you conform your behavior to the following Code of Conduct:

    1. I will treat everyone whom they encounter with respect.
    2. I will not engage in unsportsmanlike conduct towards any other coach, player, parent, participant,
       official or any other attendee.
    3. I will not engage in unsportsmanlike behavior towards any coach, parent, player, participant
       official or any other attendee.
    4. I will not engage in any behavior which would endanger the health, safety, or well-being of any
       coach, parent, player, participant, official, or any other attendee.
    5. I will not use drugs, alcohol or tobacco products while involved in any youth soccer activities,
       whether training, attending games, or officiating.
    6. I will not use profanity, obscenity or any other offensive language.
    7. I will endeavor to ensure that no parents, spectators or anyone associated with my team to use
       profanity, obscenity or any other offensive language while within the hearing of players or
       officials.
    8. I will not engage in verbal or physical abuse towards any other coach, player, parent, participant,
       or official.

Anyone who fails to conform to the preceding Code of Conduct while attending, coaching, training,
officiating or participating in an event sanctioned by the My Soccer Academy will be subject to disciplinary action.


Player ________________________ Signature ______________________ Date ________

Parent ________________________ Signature ______________________ Date ________

Parent ________________________ Signature ______________________ Date ________

Staff ________________________          Signature ______________________ Date ________

				
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posted:5/29/2012
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