HSC Online Player Data Form or Tryout Registration (if using after tryouts info is needed to have on file for your player, no tryout fee required)
Hit "tab" to move from field to field.
Player Information Parent Information
First Name:
Last Name:
Address:
City:
State:
Zip:
Gender: Male:   Female:
Date of Birth: (mm/dd/yyyy)
Position:
Club/Team Played on Last Season:
My current HSC jersey number is:
My choices for jersey numbers are: 1st:  2nd:  3rd:
NOTE: There is no guarantee you will get the jersey numbers requested. The club and coaches make final decisions on player numbers.
First Name:
Last Name:
Phone: (999-999-9999)
Cell Phone: If no cell phone, then enter n/a.
Provide an e-mail address that will be regularly checked during the season.
Email Address:
Confirm Email Address:
Additional Email Address:
Additional Confirm Email Address:
If different than Player info, please fill in below:
Address:
City:
State:
Zip:
I would be interested in serving as a volunteer on Club projects or committees : Yes   No
Select appropriate age group - (birthday should fall between dates )

PLEASE NOTE: Players born between 8/01/00 and 7/31/01 may tryout for U9 and should select U9 age group below
U-9 (08/01/99 - 07/31/00)    U-10 (08/01/98 - 07/31/99)    U-11 (08/01/97 - 07/31/98)    U-12 (08/01/96 - 07/31/97)

U-13 (08/01/95 - 07/31/96)    U-14 (08/01/94 - 07/31/95)    U-15 (08/01/93 - 07/31/94)    U-16 (08/01/92 - 07/31/93)

U-17 (08/01/91 - 07/31/92)    U-18 (08/01/90 - 07/31/91)    U-19 (08/01/89 - 07/31/90)
Emergency Information
Emergency Contact:
Emergency Phone:
Health Insurance Name:
Physician Name:
Physician Phone:
Health Insurance Policy #:
List any medical conditions or prohibitions player has :
Parent's/Guardian's Consent
The player registrant named above has my permission to participate in the Hempfield Soccer Club (HSC) program. In consideration of your acceptance of my enrollment, I, the player and we, the parents/guardians, individually and collectively, intending to be legally bound, hereby for ourselves and our heirs, executors and administrators waive and release the HSC, its agents and representatives, from any and all claims or rights to damages for injuries or losses suffered by me the player, directly or indirectly, in training for, or traveling to and from, or competing in or while attending any future Hempfield Soccer Club functions. I acknowledge that the registration fee includes only secondary accident insurance coverage. I consent for medical treatment for my child in the event of an emergency.
Photograph Release:
I give my permission and consent for photographs of my child to be taken during HSC activities. I further give permission and consent that any such photographs may be published and used by HSC and its agents, to illustrate and promote the HSC programs.
EPYSA RELEASE STATEMENT
I, the parent/guardian of the registrant, a minor or adult registrant of legal age, agree that I and the registrant will abide by the rules of EPYSA and the HSC, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the EPYSA and HSC accepting the registrant for its soccer programs and activities (the "Programs"). I hereby release, discharge and/or otherwise indemnify the EPYSA and HSC and its affiliated organizations and sponsors, their employees and associated personnel, including owners of fields or facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrants participation in the Programs, and/or being transported to or from the same which transportation I hereby authorize.
By clicking submit, I accept and acknowledge the consent and release information,
and I have provided correct information for registration.