WORCESTER CITY SOCCER ACADEMY REGISTRATION FORM

1
Thank you for your interest in the Worcester City FC Winter Clinic.

Our clinic is designed for boys and girls ages 4–13 and focuses on developing technical soccer skills, confidence, teamwork, discipline, and a love for the game in a fun and supportive environment.

Current Session: Winter Clinic

Location: ACE Indoor Gym – 51 Gage St, Worcester, MA

Training Days: Fridays

Time: 6:30 PM – 8:00 PM

Fee Information:

● First session is FREE for all new players

● $15 per session or $50 per month

Please complete the registration form below. A parent or guardian must fill out this form for each player.
2
First Name
Last Name
3
Birth Date
Month
Day
Year
4
Player Age
5
Gender
Male
Female
6
Current Grade
7
Does your child have previous soccer experience?
Yes
No
8
If yes, please briefly describe previous soccer experience
9
Parent/Guardian Full Name
First Name
Last Name
10
Relationship to Player
Please Select
Please Select
Mother
Father
Guardian
Other
11
Primary Phone Number
12
Secondary Phone Number
13
E-mail
example@example.com
14
Home Address
15
Emergency Contact Full Name
First Name
Last Name
16
Relationship to Player
Please Select
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
17
Emergency Contact Phone Number
18
Alternate Emergency Contact
19
Does your child have any medical conditions, allergies, asthma, or injuries we should know about?
Yes
No
20
If yes, please explain
21
Is your child currently taking any medication?
Yes
No
22
If yes, please explain
23
Program Registering For
Please Select
Please Select
Worcester City FC Winter Clinic
24
Current Session
25
Training Location
ACE Indoor Gym – 51 Gage St, Worcester, MA
26
Training Schedule
Fridays | 6:30 PM – 8:0
27
First Session FREE for New Players

Training Fees:

$15 Drop-In (Per Session)

$50 Monthly
28
Payment Preference
Pay Per Session ($15)
Monthly Payment ($50)
First Session Free (New Player)
29
Preferred Payment Method
Cash In person
Cash App
Venmo
Other
30
If Other, please specifyOther (Specify: ________________________________________
prevnext( X )
10
USD
25
USD
50
USD
100
USD
Description
USD
+ OR enter a custom value
Payment Methods
Credit Card
First Name
Last Name
Cash App
After submitting the form, you will be redirected to the Cash App Pay to complete the payment process.
31
Please make sure players bring the following to training:

▪︎ Indoor soccer shoes or sneakers

▪︎ Water bottle

▪︎ Comfortable athletic clothing

If your child already has a Worcester City FC jersey, please bring it
32
Does your child currently have a Worcester City FC jersey?
Yes
No
33
If yes, jersey number (if known)
34
If interested in future uniform availability, select below
Yes
No
35
Player Shirt Size
Please Select
Please Select
Youth XS
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
36
Who is authorized to pick up your child after training?
37
Will your child ever need transportation assistance to practice?
Yes
No
Maybe / Occasionally
38
If yes, please explain
39
Worcester City FC may occasionally take photos or videos during training sessions, scrimmages, and events for promotional, social media, or website purposes.
40
Do you give permission for your child to appear in photos/videos used by Worcester City FC?
Yes, I give permission
No, I do not give permission
41
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in all activities prepared by staff during the selected clinic. In exchange for the acceptance of said child’s candidacy by Worstar FC. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless WSFC. and all its respective coaches, staffs, and representatives from all liability for injuries to said child arising out of traveling to, participating in, or returning from selected clinic sessions.

In case of injury to said child, I hereby waive all claims against Worstar FC including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including soccer. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

I allow taking photography of this player that can be used for clinic Worstar FC portfolio or advertising.
42
I have read and agree to the Parent Consent & Liability Waiver
I Agree
43
Parent/Guardian Full Name
44
Date
Date
Month
Day
Year
45
Please share any additional information you would like the coaching staff to know about your child
46
Signature
Should be Empty: