Cleveland Select Soccer Club
9945 Bainbridge Road | Auburn, Ohio, 44023
Tel. 216.926.3769 | email: dani@clevelandselect.com
CS Soccer Club
cleveland select
Cleveland Select » Registration form
US Soccer Club716   8th. Ave. North, Myrtle Beach, SC 29577 | Phone: (843) 429-006
email: admin@usclubsoccer.org | Website: www.usclubsoccer.org
Member of the United States Soccer Federation
US Club Soccer Form
Registering for:
Outdoor Fall   Outdoor Spring   Indoor session 1   Indoor session 2
CLUB REGISTRATION CONFIRMATION
Club name : Cleveland Select
City : Cleveland
State : Ohio
I hereby consent to the above named club registering me with US Club Soccer.  I understand that I may be registered to only one US Club Soccer member club at any time.

[Note: it will not be necessarey to complete this form again as long as the player is with this club.]
Player Signature (type name) :        
       
Parent/Gardian Signature (type name) :        
       
Date (mm/dd/yyyy) :            
           
PLAYER INFORMATIONS
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
   
PLAYER MEDICAL INFORMATION
Allergies            
Other Medical Conditions
Physician   Physician phone        
         
Medical / Hospital Insurance Company   Medical / Hospital Insurance Phone
 
Policy Holder's Name   Policy Number
 
CLUB REGISTRATION CONFIRMATION
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 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 player’s participation in 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)
   
PICTURES
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
    newsletter
    NEW!!!
    - CS Newsletter Nr. 2
    / download PDF or zip
    - CS Newsletter Nr. 1 / download PDF or zip
     
    what's new
    Tryouts
    To arrange a Tryout at any point in time, please contact Dani.
    Please click on the schedule to find Location / Age Group and Times.
    Every player needs to mail in the Tryout Form and 175$ deposit prior to attending. If you make the Team, the 175$ deposit will be applied in FULL towards your fees. If you donít make the team, the Tryout will cost 10$, and you will be reimbursed the 165$ that is left.
     
    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

     
    tryouts

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

    CS Tryouts

    awards & cups

    Cleveland Select Soccer Club Awards & Cups.

    CS Awards & Cups


     
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