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UC PREMIER Competitive Assessment Form
UC PREMIER Competitive Assessment Form
evelyncastaneda
2017-06-05T09:57:46-07:00
ASSESSMENT WAIVER\REGISTRATION FORM
PLAYER INFORMATION
Player Name
*
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Birth Date
*
MM
DD
YYYY
Phone
*
Position
*
Secondary Position
*
Prior Club
*
2
*
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Gender
*
Male
Female
Medical Condition
Y
N
Medical Condition Description
Comments
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name
*
Home Phone
*
Mobile Phone
Parent/Guardian Email
*
Parent/Guardian Name #2
Home Phone
Mobile Phone
Parent/Guardian #2 Email
As the parent/legal guardian of the above-named player, or player age 18 or over by clicking submit I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent. I agree to hold harmless UC Premier and it agents and employees and hereby release them from any liability on account of injuries sustained by the player while participating in any activities. I give consent for the above player to be photographed, videotaped or filmed while participating in any soccer activities and the resulting photos / film to be used by UC Premier and its agents and employees for educational and promotional purposes. I have read and understand the above. I also acknowledge that players will be notified of team selection via the team manager or head coach after the assessment and accept that the decision of UC Premier will be final.
NOTE:
You will receive an email confirmation, please print/sign and bring with you to the location indicated by the UC Premier Representative who contacts you.
AOL users
AOL Users have been experiencing issues with receiving confirmation notice, but rest assured your pre-registration has been received.
Comments
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