Fall 2018 Registration

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FC Valencia Junior Academy – Fall 2018

Fall 2018 – Registration is NOW OPEN

Please complete the following form:

Player Registration (1-3 Players)

Name*
First Last
Email*
Phone*
Relationship to Player*
Address*
Street Address Address Line 2 City State ZIP Code
Emergency Contact
Emergency Contact*
First Last
Emergency Contact Phone*
Please list any medical conditions we should be aware of:
If there are any medical conditions we should be aware of, please list them. If none, you may leave blank.
Waiver Aknowledgement*
- Yes, I agree with the waiver terms and conditions listed below.
I, the undersigned parent or legal guardian of the above named participant, a minor, hereby release, discharge and agree to hold harmless Creative Soccer Enterprises, Inc./FC Valencia, its employees, volunteers, officials, sponsors and other representatives from any and all claims, demands, costs, expenses and compensation arising out of or in any way related to any physical injury or other damage that may result to said participant while participating in any Creative Soccer Enterprises, Inc./FC Valencia, clinic, tryout and/or practice. I hereby give my 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. This waiver is valid for a period of twelve months from the date signed.
Signature*
Parent or legal guardian must sign to agree with the waiver terms and conditions listed above.
Todays Date
Player Information
Players to Register
Player Name:*
First Last
Gender:*
- Female
- Male
DOB*

Players Date of Birth
Player Headshot
Accepted file types: jpg, jpeg, gif, png, pdf.
This is an optional field, however by providing a photo now it will save time in the future.
Training Kit*
Does the player need training attire? **We require all Junior Academy players to wear the full provided jersey to all training sessions and games. If your player has the full FCV-JA training kit from Spring 2018, as pictured above, and everything still fits, select "We'll wear the Spring Kit" and receive a $30 discount.
Jersey Size:*
Estimate the size of jersey the player wears.
Name (Player 2):
First Last
Gender (Player 2):
- Female
- Male
DOB (Player 2)

Players Date of Birth
Headshot (Player 2)
Accepted file types: jpg, jpeg, gif, png, pdf.
This is an optional field, however by providing a photo now it will save time in the future.
Training Kit (Player 2)
Does the player need training attire? **We require all YSL players to wear the full provided jersey to all training sessions and games. If your player has the full YSL training kit from Spring 2017, as pictured above, and everything still fits, select "We'll wear the Spring 2017 Kit" and receive a $30 discount.
Jersey Size (Player 2):
Estimate the size of jersey the player wears.
Name (Player 3):
First Last
Gender (Player 3)
- Female
- Male
DOB (Player 3)

Players Date of Birth
Headshot (Player 3)
Accepted file types: jpg, jpeg, gif, png, pdf.
This is an optional field, however by providing a photo now it will save time in the future.
Training Kit (Player 3)
Does the player need training attire? **We require all YSL players to wear the full provided jersey to all training sessions and games. If your player has the full YSL training kit from Spring 2017, as pictured above, and everything still fits, select "We'll wear the Spring 2017 Kit" and receive a $30 discount.
Jersey Size (Player 3):
Estimate the size of jersey the player wears.
How did you hear about our program?
Have you trained with us before?
How did you hear about our program?*
other detail:
Payment
Coupon

If you have a coupon code, please enter it now.
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Fall 2018 Registration

Emergency Contact

Player Information

How did you hear about our program?

Payment