Player Information
*indicates a required field

*Players Last Name:
*Players First Name:
*Email:
*Gender:
*Age group:
*Birthdate (mm/dd/yyyy):
*Mailing Address:
*City:
*State/Zip	/
*Home Phone:
Cell Phone:

*Name of School you will attend in 2009-2010:
*Are you planning to play for your school?
*Is soccer your only sport?
If not, is soccer your primary sport?
Position:
Most recent club:

Parent Info

*Parent 1 Name:
Email:
Cell Phone:

Parent 2 Name:
Email:
Cell Phone:

Availability

Please indicate your availability for the following:

Winter Tournaments	Nov 2009 - Feb 2010	Yes No
Spring Break	Can you commit to playing over Spring Break?	Yes No

Liability Waiver:

As parent or guardian of the above applicant, I agree with the following liability waiver: I grant permission for the above mentioned player to participate in the Ohio Galaxies tryouts. I assume all risks and hazards incident to such participation, including risk of serious injury, and do hereby release and waive all claims against the Ohio Galaxies Football Club, its officers, directors, coaches, sponsors, volunteers, and other participants. I grant permission for emergency first aid to be given to my child in case of injury. If my child needs medical treatment, and my consent cannot be obtained, I hereby agree that Ohio Galaxies Football Club may consent to appropriate medical treatment for my child. This will be in effect during the current tryout dates. I will be responsible for any cost of medical treatment incurred at the tryout during this period of time.

I have read and agree to the above liability waiver.

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Player Information *indicates a required field

Player Information
*indicates a required field