TINY TOTS--Under 6 Soccer Registration Page

M i n d        B o d y      S p i r i t     S o c c e r

-Tiny Tots--Under 6 Soccer 
Athens Mondays behind Athens Community Center 701 East State Street
Ages 3-6
Dates April 10, 17, 24// May 8, 15, 22

Parkersburg Wednesdays at Dean Scott Fields
Ages 3-6
Dates April 12, 19, 26// May 10, 17, 24



Athens Soccer Academy Registration Form

Player Information Section


Child's Age/DOB__________________________________________________________

Parent Information Section

Name ________________________________________________________________ 

Emergency Contact #____________________________________________________


Phone # Home  ____________________________Cell_________________________ Text?_________________________________________________________________                

Email_________________________________________  Are you on Facebook?_____

Does your child have known allergies or medical issues? Y/N

If yes, please indicate_________________________________________________________________

Are there any other things you would like us to know as we work with your child?

 Child's Doctor                                                            Doctor's phone


By signing this form, I voluntarily assume all risk of personal accident, injury, damage and/or loss as a result of my child's participation with Athens Soccer Academy.  Therefore, I agree to release the Athens Department of Parks and Recreation, the Greater Athens Soccer Association, Southeastern Ohio Soccer League, all sponsors, Tad Albano and Athens Soccer Academy, and its officers and any local individuals acting on behalf of these entities, from responsibility for any and all damage or injury of any kind as a result of my child's participation.  I grant Athens Soccer Academy the right to take photographs and/or videos of my child in connection with the above participation.  I authorize Athens Soccer Academy, its assigns and transferees to copyright, use and publish the same in print and/or electronically.  I agree that Athens Soccer Academy may use such photographs, with or without name, and for any lawful purpose, including for example such purposes as Athens Soccer Academy publicity, illustration, advertising, and web content.


Parent's Signature____________________________________________  Date____________________________________________


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