Registration

Complete the form below. Registrations are reviewed by club admins before placement. Thank you for your interest in Gladiators FC.

Registering more than one child? Fill out the first player, then use "Add another player" to add each additional child. Each player has their own medical information and document upload. The parent/guardian, emergency contact, and signature below apply to all players you list.

Player * First name * Last name * Date of birth * Gender Desired team / division Requested team Program type Jersey size Requested jersey # (primary) Requested jersey # (alternate)

Leave blank to have a number assigned. Alternate is used if your primary is already taken on the team.

Primary position Alternate position

Optional. Suggest your player's best positions; the coach confirms these.

Address City State Zip Prior experience

Organizations registered with

USYS (US Youth Soccer) US Club Soccer Other

Medical Information – Player

Allergies & Conditions

Allergies Other medical conditions / medications

Physician

Player's physician Physician phone

Insurance

Insurance company Insurance phone Policy holder Policy # Group #

Proof of age

Upload one document that proves your player's date of birth (for example a birth certificate or passport). This is the only document we collect, and it is used only to verify your player's age. Once our registrar confirms the date of birth, every uploaded document is permanently deleted from our system and we keep only an audit record of who verified it and when. Accepted: PDF, JPG, PNG. Max 10 MB.

Choose file Document type

Parent / Guardian #1 * Name * Relationship Cell phone Home phone Work phone Email *

A parent account will be created for Parent/Guardian #1 so you can manage your player(s). Login details will be emailed to you.

Parent / Guardian #2 Name Relationship Cell phone Home phone Work phone Email Create a parent account for Parent/Guardian #2 so they can also manage players. Login details will be emailed.

Emergency Contact #1 * Same as Parent/Guardian #1 Name * Relationship Phone *

Emergency Contact #2 Same as Parent/Guardian #2 Name Relationship Phone

Consent, Medical Release, and Terms

Recognizing the possibility of injury or illness, and in consideration for the club accepting my son/daughter as a player in its soccer programs and activities (the "Programs"), I consent to my son/daughter participating in the Programs. I hereby release, discharge, and otherwise indemnify the club, its organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my player as a result of participation in the Programs and/or being transported to or from the Programs. I hereby authorize the transportation of my son/daughter to or from the Programs. My player has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.

Consent to Use Electronic Records and Signatures

This registration uses electronic records and electronic signatures. You have the right to receive these records on paper instead; to request a paper copy at no charge, or to withdraw your consent to electronic records (which may prevent online registration), contact the club. To use electronic records you need a device with a current web browser, internet access, an email account, and the ability to view and save PDF and HTML files. Your consent applies to this registration and to records related to your participation. Records of your signed registration are retained by the club and can be reproduced for you on request.

I have read the disclosure above and consent to use electronic records and electronic signatures for this registration. * I have read and accept the consent, medical release, and terms above, including the photo and media release, as a condition of participation, for each player listed in this registration. *

By typing my full legal name below and clicking Submit Registration, I intend this to be my legal electronic signature, executed with the intent to sign and to be bound by the terms above for each player listed. I understand it has the same legal effect as a handwritten signature.

Parent / guardian full legal name (electronic signature) * Relationship to player(s)

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