Cleveland Select Soccer Club
9945 Bainbridge Road | Auburn, Ohio, 44023
Tel. 216.926.3769 | email:
CS Soccer Club
cleveland select
Cleveland Select » Registration form
US Soccer Club716   8th. Ave. North, Myrtle Beach, SC 29577 | Phone: (843) 429-006
email: | Website:
Member of the United States Soccer Federation
US Club Soccer Form
Registering for:
Outdoor Fall   Outdoor Spring   Indoor session 1   Indoor session 2
Club name : Cleveland Select
City : Cleveland
State : Ohio
I hereby consent to the above named club registering me with US Club Soccer. 
Player Signature (type name) :        
Parent/Gardian Signature (type name) :        
Date (mm/dd/yyyy) :            
Player's Name   Birthdate (mm/dd/yyyy)
  Age Group   Gender
        for correct age group
please check the online age specifier
Street Address   City   zip
Father Name   Father's Home Phone   Father's Cell Phone
Mother Name   Mother's Home Phone   Mother's Cell Phone
Father's Email Address   Mother's Email Address
Emergency person details
In an emergency when parent/gardian cannot be reached, please contact the following:
Contact Person   Home Phone   Cell
Contact Person 2   Home Phone   Cell
Other Medical Conditions
Physician   Physician phone        
Medical / Hospital Insurance Company   Medical / Hospital Insurance Phone
Policy Holder's Name   Policy Number
I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the Cleveland Select Soccer Club, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that playerís participation in Cleveland Select Soccer Club, US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.
  (Agreement for Electronic Submission) By checking this box and submitting this e-Registration form, I acknowledge that: I am the parent/guardian authorized to consent on the player’s behalf; I have reviewed this form and the information in contains and represent that it is accurate; and I agree to submit this form electronically with the intent to be bound by its terms and conditions.
Parent / Gaurdian Signature (type name)   Relation to player   Date (mm/dd/yyyy)
Please attach COLOR photo (Black and White not acceptable)
Pictures must be update yearly. Please DO NOT use scanned images.
Iinstructions: Take a picture with a digital phone or camera of each item, send it to yourself via email and save them to your computer then upload it to the website.
Copy of Birth Certificate   Player Picture (face only)
    JPEG format Birth Certificate < 1,5 Mb
    Minimum 1024 pixels height
      JPEG format Player Picture < 1,5 Mb
    Minimum 1024 pixels height
    All fields are mandatory
    CS Soccer Club
    - CS Newsletter Nr. 3 / download PDF or zip
    - CS Newsletter Nr. 2 / download PDF or zip
    - CS Newsletter Nr. 1 / download PDF or zip
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    mini lyons

    Soccer Program for the 5-8 year old - professional coaches - this unique program will focus on small-sided soccer, the technical and tactical aspects of soccer training, foot skills and Lot's of FUN.

    CS Mini Lyons


    If you missed our Tryouts and are looking for a team in the Fall, please call Dani - 216.926.3769 or email

    CS Tryouts

    awards & cups

    Cleveland Select Soccer Club Awards & Cups.

    CS Awards & Cups

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