Create New Player

First Name *

Last Name *

Gender *

Male
Female

I live in North Carolina

Interested in Travel Program?

Only applies to Advanced program players

Preferred Practice Date

This only applies to Academy and First Start players

Birthday *

Competition Level *

Contact Information

Parent or Guardian Contact Information

	Contact Label	Address	City	State	ZIP
1

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Current Picture

Picture must be of player's face

T Shirt Size

Parental Waiver *

I certify that my child is in good physical condition and is physically and psychologically prepared to participate in this program. I hereby give my consent to Chesapeake United Soccer Club to provide my child, through staff of its choice, customary medical/athletic training attention, transportation, and emergency medical services as warranted in the course of my child’s participation. I am fully aware of, and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated with my child's participation in this event. I further agree on behalf of myself, my child and my heirs and personal representatives that the CHESAPEAKE UNITED SOCCER CLUB, along with the coaches, volunteers, employees, agents, officers, and directors of this organization, shall not be liable for any injury, loss of life, or other loss or damage occurring as a result of my child's participation in the event.

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Chesapeake United Soccer Club

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