Register

If you’re interested in getting private lessons from us, please fill out the form below and we’ll get in touch with you as soon as we can!

Player Information:
Name:*
First Last
Age:*
Birth Date:*
Date Format: MM slash DD slash YYYY
Gender:*
- Male
- Female
New Player?
- Yes
- No
Parent/Guardian Information:
Name:*
First Last
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Emergency Contact Information:
Name*
First Last
Relation to Player:*
If applicable, list any medical problems(s)/physical limitation(s) the player has:
Waiver:
We, the registrant and the registrant’s legal parent or guardian, hereby agree and acknowledge the following: (1) We recognize the inherent risk of serious or permanent physical injury and possible death associated with youth soccer activities and games. In consideration for Coach Charles Lawrence accepting the youth player’s registration and participation in practices, we hereby release, discharge and/or otherwise indemnify and hold harmless Coach Charles Lawrence, his affiliated organizations and sponsors, volunteers, and associated personnel, including the owners of fields and facilities utilized for the practices, against any claim, lawsuit or written demand. (2) We consent to emergency medical care prescribed by a duly licensed Health Care Provider or Dentist. This care may be given under whatever conditions are necessary to preserve the registrant’s well-being and we hereby agree to be financially responsible for all costs associated with such treatment. (3) We consent to Coach Charles Lawrence taking photographs, video recordings, and/or sound recordings in documenting the soccer activities. We hereby grant Coach Charles Lawrence and his affiliates permission to use the negatives, prints, motion pictures, video/audio tapings, or any other reproduction of the same for educational and promotional purposes. We have read this release and waiver of liability and fully understand its terms. We understand that we waive substantial rights by signing this form. We agree to waive all such rights above including the right to file a legal action or assert a claim for personal or physical injury or death of any kind. We sign this release form freely of our own free will.
Do you accept these terms?*
- Yes
- No
You have to accept the terms to submit the form. Do you accept the terms?*
- Yes
Type out your first and last name to "sign" this document:*

Player Information:

Parent/Guardian Information:

Emergency Contact Information:

Waiver: