Champion Sports League

Spring 2023 Soccer Registration

Participant's Name

Date of Birth

Age

Age as of September 01, 2022

Parent Name

Contact Number

School or Organization Name

Coach (if known)

Does participant have any known health conditions?

Yes

No

Please explain.

In the event of an emergency, please contact: (other than parent)

Emergency Contact Phone Number

Relationship to Participant

Fee: $105.00
Please make check payable to WHTC or pay using the link at the bottom of this form.

Please select jersey size

Please select shorts size

Interested in coaching or sponsoring a team? Team Coach or Team Sponsor (circle one please)

Are you interested in coaching or sponsoring a team?

I'd like to be a Team Coach

I'd like to be a Team Sponsor

Coach Name

Sponsorship Fee is $200 / Sponsorship Name

Legal Release (Please Sign):

I, the parent/legal guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Harvest Christian Academy, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with the sport and in consideration for HCA, accepting the registrant for its sports programs and activities (the “programs”), I hereby release, discharge and/or otherwise indemnify HCA , its affiliated organizations and sponsors, their employees, volunteers and associated personnel, including owners of fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the programs or my involvement as a viewer of the programs.

Legal Release Signature

Date

CONSENT FOR MEDICAL TREATMENT (MINOR)

As the parent or legal guardian of the above-named player, 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.

Consent for Medical Treatment Signature

Signature Date

Registration is not complete without payment.

Click above to make payment but please be sure to return to this page and hit "Submit" to complete registration.