Hill Country FC
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Hill Country FC Registration
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Indicates required field
Program:
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Soccer Club
Youth Academy
3v3 Youth League
3v3 Adult League
Player Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Gender
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Male
Female
DOB (mm/dd/yyyy)
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# of Seasons played
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Uniform Size
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Youth Extra Small
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Perferred Uniform Number
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On July 31, 2013 the age of my child was?
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On July 31, 2013 my child was in grade?
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Name Parent 1
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First
Last
Main Contact Phone Number
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Alternate Phone Number
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Phone Type
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Home
Cell, Text Accepted
Cell, Text Not Accepted
Work
Phone Type
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Home
Cell, Text Accepted
Cell, Text not Accepted
Work
Email Parent 1
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Name Parent 2
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First
Last
Main Contact Phone Number
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Alternate Phone Number
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Phone Type
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Home
Cell, Text Accepted
Cell, Text Not Accepted
Work
Phone Type
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Home
Cell, Text Accepted
Cell, Text Not Accepted
Work
Email Parent 2
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Emergency Contact
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First
Last
Phone Number
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Medical Conditions
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Doctor's Name
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First
Last
Phone Number
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Choose One
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I agree
I do not agree
I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the HCASF, the membership organizations that govern the sport registered for, and sponsors.
I agree to have my child to practice and the game on time and will contact the coach or team manager when my child is going to be absent.
I recognize the possibility of physical injury when participating in a sport or fitness activity and will not place a claim on behalf of the registrant against HCASF, its membership organizations, employees, board members, sponsors, or owners of facilities or fields used.
Choose One
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I agree
I do not agree
CONSENT FOR MEDICAL TREATMENT: As parent/guardian of the above registrant, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor or Dentistry. This care maybe given under whatever conditions are necessary to preserve life, limb, or wellbeing of my dependent.
By entering my name and clicking the submit button I agree that all entered information is correct to the best of my knowledge and I will provide a copy of my child's birth certificate by the first practice.
Name
*
First
Last
Date (mm/dd/yyyy)
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Submit
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