Registration

Age Group*

Program

Your First and Last Name*

Player First and Last Name*

Player's Birthdate

Street Address*

Town / City*

Postal Code*

Phone*

Email*

Select Shirt Size*

Emergency Contact*

Emergency Contact Phone*

Payment Method*

Payment: Cash; e-transfer (pacificsoccer@hotmail.com or by Cheque payable to Pacific Soccer Inc.

Parental Release/Consent: The undersigned Parent/Guardian hereby release the Pacific Soccer Inc. (PSA), and all its employees and volunteers for any claims on account of any injuries which may be sustained by our (my) child while attending Pacific Soccer Academy. We (I) agree to indemnify the (PSA) and its employees for any claim which may hereafter be presented by (our) my child as a result of any such injuries. Furthermore, I (we) certify that within the past year, my child has had a physical examination and is physically able to participate in sports activities. In the event of illness or injury, we (I) give consent for medical treatment and permission to the attending physician to hospitalize and secure proper treatment.

Terms*

I Agree to the Terms & Conditions

Payment Details

Pacific Soccer Winter Program

Pacific Soccer Fall Program

Pacific Soccer Spring Summer Program

Pacific Soccer Selects

Pacific Soccer Pre-Season Camp

Total $ 0

Payment Details

Our Coaches