PLAYER PROFILE

Player's Full Name *

Email *

Phone *

Date of birth *

What Position(s) do you Play? *

Your Grade *

Freshman
Sophomore
Junior
Senior
7th - 8th Grade
5th - 6th Grade
3rd - 4th Grade
1st - 2nd Grade
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What Team(s) do you Play for? *

Please rate your Fitness Level. *

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Your School Name *

What would You like to Achieve During our Training?

What is Holding Back from Achieving your Goals?

MEDICAL & HEALTH INFORMATION

Insurance Carrier *

Any Health Problems that can Affect your Training? *

Are you on any medications? (Inhaler for Example) *

If you have any injuries, please list them.

GUARDIAN & EMERGENCY CONTACT

Full Name *

Phone Number *

Address *

EMERGENCY CONTACT RELATIONSHIP *

Please Read The Terms and Conditions.

Disclosure / Waiver Agreement
This clinic complies with Massachusetts Board of Health regulations (105 CMR 430.190) and is licensed locally. Parents may request background checks, health care policies, and grievance procedures.

By submitting, you agree to release Global Soccer Institute and staff from any liability. Medical care may be provided if necessary. Authorization may only be granted by the Program Director.

I AGREE TO THE ABOVE TERMS & CONDITIONS!

Yes

No