“Developing the Total Player”

 

 

Player Name:___________________________________    Age:_______DOB:___________  Gender (circle one):  Male     Female

Parent’s Names:____________________________________________________________

Address:_______________________________________________________City:__________________Zip:______________

E-mail:____________________________________________________________________

Home Phone:________________________________               Cell Phone:_________________________________________

Emergency Contact

Name:______________________________ Phone:____________________________  Level (circle one):     Level 1         Level 2

Program Length (circle one):     6 Week Program     12 Week Program     Start Date (mm/dd/yyyy):_______________________

Group Members’ Names (1-7 Players):______________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Sizes (circle one):   Youth    Adult

Shirt_______     Shorts________    Socks________

As the parent/legal guardian of the previously named player, I authorize California Odyssey Soccer Club/Academy to provide any medical attention necessary to said player. In addition, I will not attempt to hold COSC/A liable for any injury which may occur during the Individual Training Program.

Parent/Legal Guardian Signature:__________________________________________   Date:____________
 

Parent/Legal Guardian Printed Name:_______________________________________