SUPER REC SOCCER ONLINE APPLICATION Parent/Guardian First Name:  * Parent/Guardian Last Name:  * Relation:  * Address:  * City:  * State:  * Zip Code:  * Home Phone:  * Work Phone:  * Email Address: Cell Phone:  * Player First Name  * Player Last Name  * Male Female DOB (MM/DD/YYYY)  * Seasons Played  * Height  * Weight  * School Name  * Grade  * Shirt Size  * Short Size  * Age Group  * Emergency Contact #1  * Phone  * Emergency Contact #2  * Phone  * List any medical problem(s):  * Comments:(I would like to play with my friend) How did you hear about us:  * MEDICAL TREATMENT AUTHORIZATION AND LIABILITY WAIVER I hereby give my consent to have an athletic trainer coach team manager emergency medical technician nurse medical treatment facility and/or doctor of medicine or dentistry or associated personnel to provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer and hereby release discharge and otherwise indemnify the Realmadrid Premier Club the High Desert Soccer Association their sponsors the USSF and its affiliated organizations and the employees and associated personnel of these organizations against any claim by or on behalf of the soccer player named above as a result of that player's participation in High Desert Soccer Association's Soccer programs and/or being transported to or from the same which transportation I hereby authorize. Security code:   * Do not enter anything in this field:

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