Midway Soccer Registration 
Season 14
Email *
Participant First and Last name *
Parent/Guardian First and Last name *
Parent/Guardian cell phone *
Additional Parent/Guardian First and Last Name
Additional Parent/Guardian cell phone
Street Address *
City  *
State  *
Zip Code *
Email Address *
Home church (if applicable)
Allergies/Special Needs (relevant to playing soccer)
Teammate Request 
Coach Request
Gender *
Birthdate *
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/
DD
/
YYYY
Grade Level (2023-24 school year) *
T-shirt size *
Practice Night preference  *

Medical and Liability Release

We realize that no activity is without the possibility of unforeseen hazards which could result in injury to an individual.  As a parent or guardian, you are to be aware of your responsibility to instruct your child of the importance of conduct which will insure safety and enjoyable time while participating in this activity.  By signing this form, you, as a parent, guardian or other responsible party, agree to assume the risks and hazards which are inherent in this kind of activity.  You also agree to absolve and hold harmless the sponsoring organizations and their representatives for damage, loss or injuries to the child for whom you sign. 


I give my child permission to participate in this activity, and give my permission to the leaders of this function to authorize any treatment deemed necessary by a licensed physician due to accident or illness during this activity.

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Photography Release

I further give my permission for the use of any photo or likeness of my child to be used by the sponsoring organizations for their use in promotional materials.
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A copy of your responses will be emailed to .
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