Old Dominion Soccer Club

Youth Academy Registration

Old Dominion Soccer Club
4925 Providence Rd, Virginia Beach, VA 23464

Email: olddominionsc@outlook.com

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:

Home Address:

* Birthdate:

* Home Phone:

III. Family Information:

* Parent/Guardian #1 - Relationship:

* 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:

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

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

If you answered YES please select the soccer club your child is registered with:

VI. We like to track how our participants hear about our programs.

How did you hear about the Youth Academy?:

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 player or parent first/last name & team name here. If not, leave blank.

Referral Info:

VII. Miscellaneous:

* Select your Session for Registration:

Please select the child's appropriate t-shirt size:

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
4925 Providence Road
Virginia Beach, VA 23464

* indicates required fields

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Youth Academy Registration