Midwest Soccer Academy-Youth Leagues
Team Registration



























AS A PARENT/GUARDIAN , I UNDERSTAND THAT THERE ARE RISKS OF INJURY WHEN 1 PARTICIPATES IN SPORTS AND 
OTHER ACTIVITIES AT THIS FACILITY (MIDWEST SOCCER ACADEMY), I ALSO UNDERSTAND THAT MIDWEST SOCCER ACADEMY IS NOT ACCEPTING OR ASSUMING  ANY DUTIES OR RESPONSIBLITIES WITH RESPECT TO MY CHILD’S OR ANY OTHER PARTY GUEST’ SAFETY THEREFORE IN CONSIDERATION OF THE PERMISSION EXTENDED TO ME TO ENTER THESE PREMISES, I RELEASE AND FOREVER DISCHARGE MIDWEST SOCCER ACADEMY, FROM ANY CLAIMS THAT I HAVE, OR MIGHT HAVE IN THE FUTURE HAVE ARISING OUT OF OR CONCERNING MY PRESENCE AT THIS FACILITY OR MY PARTICIPATION IN ANY ACTIVITY AT THIS FACILITY, AND I PROMISE TO IMDEMNIFY MIDWEST SOCCER ACADEMY AND HOLD IT HARMLESS FROM ANY CLAIMS AND RELATED DEFENSE COSTS, INCLUDING REASONABLE ATTORNEY FEES, ARISING OUT OF MY PRESENCE OR PARTICIPATION IN ANY ACTIVITIES AT THIS FACILITY. IN ADDITION, I HEREBY AUTHORIZE MIDWEST SOCCER ACADEMY AND IT’S RESIGNS TO UTILIZE AND ALL PHOTOGRAPHS, PICTURES, OR OTHER LIKENESS OF THE PARTIIPANTS THEY DEEM APPROPRIATE IN IT’S PROMOTIONAL MATERIALS.


Main Contact
Address
City, State, Zip
Coach
Phone
Email
Team Name
Grade
Special Notes
Team Name
Please submit this registration or download and mail in with a $100.00 deposit
CHARGE PAYMENT INFO
*PLEASE NOTE A 5% SURCHARGE WILL BE APPLIED TO ALL CHARGE PAYMENTS
Credit Card
Card Number
Exp.Date
Security code
Male
Female
I have read the liabilty waiver and fully understand and agree to it