Player & Parent/Guardian Information

2018 Spring Registration

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Player & Parent/Guardian Information
Emergency & Medical Contact Information
Registration Options
Review
Receipt

Player Information

First Name:*

Legal First Name

Middle Name:

Last Name:*

Legal Last Name

Birthdate:*

Gender:*

Male

Female

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School:*

Grade:*

Player's Email:*

Athlete Headshot:*

Player photo should be a headshot, no larger than 2 MB, and in a JPG or PNG file format

Birth Certificate:*

Proof of birth record should be a PDF or JPG file no larger than 2 mb

Address 1:*

Address 2:

City:*

State/Province:*

Zip:*

Country:*

Parent/Guardian Information

Parent/Guardian First Name:*

Parent/Guardian Last Name:*

Parent/Guardian Cell Phone:*

Parent/Guardian Cell Phone Receive Texts?:*

Parent/Guardian Home Phone:*

Parent/Guardian Work Phone:

Parent/Guardian Email:*

Parent/Guardian 2 First Name:

Parent/Guardian 2 Last Name:

Parent/Guardian 2 Cell Phone:

Parent/Guardian 2 Cell Phone Receive Texts?:

Parent/Guardian 2 Home Phone:

Parent/Guardian 2 Work Phone:

Parent/Guardian 2 Email:

I hereby consent to the above-named club registering me with US Club Soccer. I understand that I may be registered to only one US Club Soccer member club at any time. [Note: it will not be necessary to complete this form again as long as the player is with this club, which will hold this form unless requested by US Club Soccer.]

Parent/Legal Guardian Signature:*

Player’s Signature:*

Sync Successful:

True

False

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Sync Date:

Original Create Date:

Sync Note:

US Club Soccer Primary Registration:

Yes

Clear Current Selection

Tecos Hayward Soccer Club

2018 Spring Registration