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Youth Academy Registration
ODSC Youth Academy
*** PLEASE NOTE THAT ALL FALL YOUTH ACADEMY SESSIONS ARE CANCELLED FOR 5-10 YEAR OLDS SOCCER PLAYERS PRACTICING INDIVIDUALLY*** AGAIN, THERE WILL BE NO SESSIONS FOR INDIVIDUAL YOUTH ACADEMY. WE ARE ONLY DOING TEAM TRAINING YOUTH ACADEMY THIS FALL! PLEASE CONTACT YOUR RESPECTIVE DOC FOR MORE ASSISTANCE! ***
Old Dominion Soccer Club
4925 Providence Rd, Virginia Beach, VA 23464
Phone: 757-510-2417
ODSC Treasurer:
5120 Norvella Avenue
Norfolk, VA 23513
Read Carefully BEFORE You Begin:
1. Please make sure you fill out ALL required fields on your child's registration form.
2. Review all information for accuracy before you hit the "Submit Form" button.
3. After you submit your child's registration form you will have the opportunity to EDIT the form or ADD ANOTHER PLAYER.
4. Use the "Checkout" button to complete the registration process AFTER all your children's registration forms have been submitted.
5. Don't forget to PRINT a copy of each of your children's registration forms for your records.
I. Player Information:
*
First Name:
*
Last Name:
*
Gender:
-Select-
Male
Female
Home Address:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2005
2006
2007
2008
2009
2010
2011
*
Home Phone:
III. Family Information:
*
Parent/Guardian #1 - Relationship:
-Select-
Father
Mother
Guardian
Other
*
Parent/Guardian - First Name:
*
Parent/Guardian - Last Name:
Home Address:
*
Parent/Guardian - Home Phone:
Parent/Guardian - Cell Phone:
*
E-mail Address:
Parent/Guardian #2 - Relationship:
-Select-
Father
Mother
Guardian
Other
Parent/Guardian - First Name:
Parent/Guardian - Last Name:
Home Address (if different than player):
Parent/Guardian - Home Phone:
Parent/Guardian - Cell Phone:
E-mail Address:
IV. Waiver of Liability and Photo Release
By checking the box below, I hereby indicate that I release "Old Dominion Soccer Club" and all it's members of "ODSC" and any other party involved in the organization and administration of ODSC of any liability for any incidents that may result in any injury on or around the training site. I hereby declare that the applicant is in good health and in case of emergency I grant permission for the applicant to be given medical treatment considered advisable at a local hospital. By checking this box, I accept all responsibility and assume all cost that may be incurred in the event of any injury, accident or even death.
Additionally, I hereby grant ODSC permission to use my child's likeness in a photo, video, in other digital media in any and all of its publications, including web-based publications, without payment or consideration. ODSC may edit, alter, copy, exhibit or distribute this media without any inspection or approval of this finished product.
I have read and agree with the Waiver of Liability and Photo Release. I hold harmless, release, and forever discharge ODSC from all claims, demands, and causes of action, which I, my heirs, or any other representative may execute.
*
*
Special medical conditions or allergies?:
Yes
No
If yes, please give details:
V. The Virginia Youth Soccer Association (VYSA) requires that each participant be registered through a USSF organization and that a report be submitted each season for our Youth Academy.
*
Is your son/daughter registered with a local soccer club for the upcoming season?:
Yes
No
If you answered YES please select the soccer club your child is registered with:
-Select-
Beach FC
VA Rush
Chesapeake United Soccer Club
Chesapeake United
Norfolk United
Other
VI. We like to track how our participants hear about our programs.
How did you hear about the Youth Academy?:
-Select-
Email
Virginian Pilot or PilotOnline.com
HamptonRoads.com
Nextdoor.com Events Calendar
Social Media (Facebook, Twitter, etc.)
Friends/Family
Other
Help grow our ODSC Family by referring a friend! Training Referral bonus is provided for those who refer friends to our family. Were you referred to us, if so, enter name here. If not, leave blank.:
VII. Miscellaneous:
*
Select your Session for Registration:
-Select-
Fall Academy
Spring Academy
Please select the child's appropriate t-shirt size:
-Select-
Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Reminder:
1. Have you filled out ALL required fields on your child's registration form?
2. Have you reviewed all information for accuracy?
If so, hit the "Submit Form" button to enter your child's registration form and view the "Completed Online Forms Summary" page.
3. On the "Completed Online Forms Summary" page you can EDIT a profile or ADD ANOTHER PLAYER.
4. Use the "Checkout" button on the summary page to complete the registration process AFTER all your children's registration forms have been submitted.
5. Don't forget to PRINT a copy of each of your children's registration forms for your records.
6. Mail payment after submitting registration to:
ODSC Treasurer
5120 Norvella Avenue
Norfolk, VA 23513
* indicates required fields