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2011 WNY NCAAA Premier Soccer Combine
Sunday November 20th, 10:00am – 2:00pm, Premier Sports
Registration CLOSED!!!!!!!

For more information view our printable registration form
Save money for college

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2011 Combine / Tryout Registration

Register in two easy steps...
Step 1: Fill out the electronic form below (or print out the registration form and mail it to us).
Step 2: Once completing this form you will be sent to our secure PayPal page to finish.

Athlete Information

Name*
Date of Birth*
Address*
City*
State*
ZIP*
Phone (Home)*
Phone (Cell)
Email*
Father's Name*
Mother's Name*
 

High School Information
High School*
Current Grade*
Club Team*
Position*
HS GPA*

Medical Information

Insurance Carrier*
Policy Number*
Physician's Name*
Physician's Phone*
Known Medical Conditions
Medications
Emergency Contact*
Emergency Phone*

I/We give permission for any medical attention necessary to be administered to my/our child by a licensed Medical Professional in the event of an accident or injury until I/we can be contacted. This release is effective for the 2011 season. I /we will assume responsibility for payment of treatments.

I/We the parent of the above named child, give my approval for his/her participation in any and all activities of the RPA Inc. during the 2011 season.

I/We do further release, indemnify and hold harmless any liability, direct or indirect, from anyone representing the RPA Inc., and/or any of the members, officers, organizers, supervisors, any and all of them. In case of injury to my child, I hereby waive all claims against the organizers.

I am the parent/guardian noted above. I have read the waiver above and agree to all the terms and conditions.
Parent E-Signature*

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