L.A. Salsa S.C.

UPSL - Inactive Teams

PYSO Registration Summer Futsal at Artesia Park (July 31-Sept 29)

PYSO Summer Futsal at Artesia Park $150/player

<form-template>
	<fields>
		<field type="header" subtype="h2" label="Parent Information" class="header"></field>
		<field type="text" required="true" label="Parent / Gaurdian First Name" subtype="text" class="form-control" name="parent--gaurdian-first-name"></field>
		<field type="text" required="true" label="Parent / Gaurdian Last Name" subtype="text" class="form-control" name="parent--gaurdian-last-name"></field>
		<field type="text" required="true" label="Relation" subtype="text" class="form-control" name="relation"></field>
		<field type="text" required="true" label="Street Address" subtype="text" class="form-control" name="street-address"></field>
		<field type="text" required="true" label="City" subtype="text" class="form-control" name="city"></field>
		<field type="text" required="true" label="State" subtype="text" class="form-control" name="state"></field>
		<field type="text" required="true" label="Zip" subtype="text" class="form-control" name="zip"></field>
		<field type="text" required="true" label="Home Phone" subtype="text" class="form-control" name="home-phone"></field>
		<field type="text" required="true" label="Work Phone" subtype="text" class="form-control" name="work-phone"></field>
		<field type="text" required="true" label="Cell Phone" subtype="text" class="form-control" name="cell-phone"></field>
		<field type="text" required="true" label="Email" subtype="text" class="form-control" name="email"></field>
		<field type="header" subtype="h2" label="Player Information" class="header"></field>
		<field type="text" required="true" label="Player First Name" subtype="text" class="form-control" name="player-first-name"></field>
		<field type="text" required="true" label="Player Last Name" subtype="text" class="form-control" name="player-last-name"></field>
		<field type="select" required="true" label="Player Gender" class="form-control" name="player-gender">
			<option label="Female" value="female" selected="true">Female</option>
			<option label="Male" value="male">Male</option>
		</field>
		<field type="text" required="true" label="DOB" subtype="text" class="form-control" name="dob"></field>
		<field type="text" label="Seasons Played" subtype="text" class="form-control" name="seasons-played"></field>
		<field type="text" label="Height" subtype="text" class="form-control" name="height"></field>
		<field type="text" label="Weight" subtype="text" class="form-control" name="weight"></field>
		<field type="checkbox-group" label="Ability Level" class="checkbox-group" name="ability-level">
			<option label="Beginner" value="beginner">Beginner</option>
			<option label="Intermediate" value="intermediate">Intermediate</option>
			<option label="Advanced" value="advanced">Advanced</option>
		</field>
		<field type="select" label="Shirt Size" class="form-control" name="shirt-size">
			<option label="Youth Small" value="youth-small" selected="true">Youth Small</option>
			<option label="Youth Medium" value="youth-medium">Youth Medium</option>
			<option label="Youth Large" value="youth-large">Youth Large</option>
			<option label="Adult Small" value="adult-small">Adult Small</option>
			<option label="Adult Medium" value="adult-medium">Adult Medium</option>
			<option label="Adult Large" value="adult-large">Adult Large</option>
			<option label="Adult X-Large" value="adult-xlarge">Adult X-Large</option>
		</field>
		<field type="text" required="true" label="Emergency Contact 1" subtype="text" class="form-control" name="emergency-contact-1"></field>
		<field type="text" required="true" label="Emergency Phone 1" subtype="text" class="form-control" name="emergency-phone-1"></field>
		<field type="text" required="true" label="Emergency Contact 2" subtype="text" class="form-control" name="emergency-contact-2"></field>
		<field type="text" required="true" label="Emergency Phone 2" subtype="text" class="form-control" name="emergency-phone-2"></field>
		<field type="textarea" label="If applicable list any medical problem(s) / physical limitation(s) the player has:" class="form-control" name="if-applicable-list-any-medical-problems--physical-limitations-the-player-has"></field>
		<field type="paragraph" subtype="p" label="I hereby release, discharge and/or otherwise indemnify and hold harmless Cal South, L.A. Salsa SC and its affiliated organizations and sponsors, volunteers, their employees and associated personnel, including the owners of fields and facilities utilized for the Youth Programs, against any claim, lawsuit or written demand, including but not limited to any claims for personal or physical injury or death, by or on behalf of the registrant as a result of the registrant's participation in the Youth Programs and/or being transported to or from the same, which transportation we hereby authorize. I 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 life, limb or registrant's well-being and I hereby agree to be financially responsible for all costs associated with such treatment. I understand that there are risks involved with my child’s participation in the L.A. SALSA Soccer Club competitive soccer training, camps, clinics, and games. I know of no physical or mental problem that will affect my child’s ability to safely participate in these training sessions, camps, clinics, and games. I certify that my child is in good general health, and may participate in strenuous physical activities. I hereby release and forever discharge the L.A. SALSA Soccer Club and all their agents, employees and affiliated entities from any and all liability, claims, demands, and cause of action for personal injury or death, property damage, and/or other loss suffered by my child in connection with their participation in soccer related activities. I acknowledge and accept that this Release and Waiver is intended to be binding on the family, estate, heirs, executors, administrators, and assigns of my child. I further acknowledge and accept that this Release and Waiver is intended to be as broad and inclusive as permitted by the laws of California and agree that if any portion of this Release and Waiver is invalid, the remainder will continue to be in full force and effect. I agree that this Release and Waiver binds my child and/or me to all of its terms. CDC protocol shall be strictly followed and enforced for anything that appears to be a concussions. I hereby grant permission to the L.A. SALSA Soccer Club and its legal representatives, assigns, and those acting on its behalf, to use any picture, video or audio recording of my child taken in connection with any soccer related activity for all manner of advertising, trade, promotion, exhibition, or any other lawful purpose related to youth soccer whatsoever and in any form or medium.I have read this release and waiver of liability and fully understand its terms. I understand that we waive substantial rights by signing this form. I 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. I sign this release form freely of our own free will." class="paragraph"></field>
		<field type="text" required="true" label="Waiver Signature - Type your full legal name to indicate you agree with the above waiver" subtype="text" class="form-control" name="waiver-signature--type-your-full-legal-name-to-indicate-you-agree-with-the-above-waiver"></field>
	</fields>
</form-template>