Women's Division Registration

Community Announcements

Women's Division Registration
Before registering, please be familiar with both FIFA Laws of the Game and Code of Ethics

Last Name

First Name

Street Address

City

State

Zip Code

Phone

Email Address

Team
Choose one team

Surge
Quest
Chemical Valley Chokers
Supastars

Did you play last season?

Yes
No

Registering in multiple divisions? If so, which?

A Division
B Division
C Division

You must fill out a separate form for each division

U.S. Citizen?
If Yes, skip next 3 questions.

Yes
No

Intent to become a U.S. citizen?

Yes
No

Was the last team you played for a member of a foreign Federation?

Yes
No

Were you 14 years of age or older when you entered the U.S.?

Yes
No

If your answer to all three questions is YES YOU MUST fill out the International Player Permission form. If you are 16 years of age you may fill out an International Clearance Waiver form.

If you are 15 years of age or younger, YOU MAY NOT PLAY in this league.

Are you 16 or 17 years of age?
IIf the answer to this question is yes you must fill out a Amateur Application form for Youth.AS WELL AS THE AMATEUR PLAYER REGISTRATION FORM.

Yes
No

Birthdate
Enter birthdate in format XX/XX/XXXX

Disclaimer Please read, sign and date this release and disclaimer. Soccer is a contact sport involving risk of serious injury, disability, or death. Not all risks are foreseeable. In consideration of being allowed to participate, I agree to release, waive, and covenant not to sue United States Soccer Federation or affiliates on account of injury, death, or property damage alleged to be caused in whole or in part by affiliates' actions or omissions.I HAVE READ THE RELEASE & DISCLAIMER AND RECOGNIZED THAT I GIVE UP SUBSTANTIAL RIGHTS BYSIGNING, I KNOWINGLY ASSUME THE RISK. FURTHER THE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE. I REALIZE THAT IF THEINFORMATION ON THIS FORM CHAGES, IT IS MY RESPONSIBILITY TO INFORM THE REGISTRAR OF ANYCHANGES THAT ARE LISTED ON THIS FORM.FURTHER I HAVE READ THE LEAGUE'S RULES OF PLAY AND WILL ABIDE BY THEM.Hitting the Submit Key is the same as an official signature and date in that you agree with the Disclaimer.

Disclaimer
You must type I Agree here