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* Indicates Required Field.

Parent's First Name *

Parent's Last Name *

Parent's Email *

Address *

City *

State *

Zip Code*

Phone *

Player's Name *

Date Of Birth (mm/dd/yyyy) *

Male or Female *
MaleFemale

School *

Previous Experience *

Please List any Physical Limitations (allergies, hearing, sight, etc.):

Shirt Size:*

Parent/Guardian Waiver & Consent: As the parent/guardian of the child named above, I hereby give my full consent and approval for my child to participate as a player/team member in FC Golden State Orange County Friday Night Futbol (FNF) and Orange County Soccer Development League (OCSDL). I understand that there are certain risks of injury inherent in the practice and play of youth soccer as well as other related activities incidental to my child's participation and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in youth soccer and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these youth soccer activities except listed above. In addition to my full consent for my child's participation. I do hereby waive, release, and hold harmless FC Golden State Orange County, its officers, coaches, sponsors, supervisors, and representatives for any injury that may be suffered by my child in the normal course of participation in youth soccer and the activities incidental thereto, whether the result of negligence or any other cause.

AUTHORIZATION TO USE PHOTOGRAPHS OR VIDEO: I further agree and consent to the use of photographs or video of the Player while participating in the FNF and OCSDL athletic programs by FC Golden State Orange County.

I have read and agree to wavier *

Date Consent Signed:*

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