Player Registration Player InformationFirst Name *Last Name *Date of Birth *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeSchool *Grade Level *Select a Grade Level3rd4th5th6th7th8th9th10th11th12thTeacherYouth T-Shirt Size *X-SmallSmallMediumLargeX-LargeXX-LargeParent/Guardian 1 InformationFirst Name *Last Name *Email AddressPhoneParent/Guardian 2 InformationFirst NameLast NameEmail AddressPhoneMedical InformationEmergency Contact Name *Emergency Contact Phone *Relationship to Child *Medical conditions or allergies (optional)Does the student have medical insurance? *YesNoPermission/Liability WaiverMay we photograph/video your child? Photos/images may be used on school and/or public displays, e.g. Facebook, website, newspaper articles.YesNoAre you interested in helping volunteer this year?YesNoDoes your child have your permission to walk home alone after practice? *YesNoDoes you child have your permission to travel by district transportation to other schools for games/tournaments? *YesNoLiability Waiver *I have chosen to allow my child, noted above, to participate in an after-school program in the Jefferson School District. I understand that the school district and its employees are not responsible for supervising my child. I also understand that I am responsible for any damages to school property or any injury to any person which my child may cause while participating in this program. In the event of an injury to my child while participating in soccer during the 2024-2025 school year, I also understand that this may happen. I promise not to bring a claim or lawsuit against the school district for any damages or injuries my child may suffer. This includes a waiver of any claims related to transportation to and from soccer games, or similar events.Parent/Guardian Signature *Submit