6v6 Indoor Tournament
May 5th, 2013
Ages: 7 to 10 Start Time 9am
Ages: 11 to 14 Start Time 1pm
Adult Men Open ages 16 and up Start Time 5pm
Register online | Teams Registration Form
Team / Club Name:_____________________ Age Group: Youth __ Adult__
Coach / Team Manager Name: _____________________________________________
Address: City: Zip: __________________________________________________________________________
Phone 1: Phone 2: __________________________________________________________________________
Email(s): ____________________________________________________________
Did you coach/play on a US Club or EPSA / Titans team in 2013? If so, which team? ___________
Team Jersey Color ________________________ Short Color ______________________
Emergency Point of Contact ________________________________________________________________
Waiver and Release: I give permission for my child /team to participate in the Edmond’s Premier Soccer Academy (EPSA) Cinqo De Mayo Indoor Tournament. I understand that soccer is a sport in which serious injuries occur. I warrant that my child/team/club has no disabilities or special health considerations that prevent him/her from participating in physical activities including soccer games. I grant permission to EPSA and its representatives to seek emergency medical care for my child/players. I, for myself, my child/players, our heirs, executors and administrators, waive, release and forever discharge EPSA, Tumwater Indoor Sports, and all its members from any and all liability, claims or causes of action arising from or related to any loss, personal injury or property damage that I, my child, players may be sustained as a result of participation this activity/tournament to be held on May 5th 2013 at: 7845 Center Street, Tumwater WA.
Coach /Club Manager/Parent Signature ______________________
Date ___________
Registration Fee: $50.00
Mail check and registration form to:
Edmond’s Premier Soccer Academy: 1420 Marvin Rd NE, Ste. C PMB 634, Lacey, WA 98516-3878
For more details email us at: edsocceracademy@gmail.com or visit us online: www.edmondpremiersocceracademy.com