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Are you a New or Returning player?*

New Player
Returning Player

WELCOME BACK TO PLAY WHERE YOU STAY!

Parent Name*

First Name Last Name

Parent's Phone Number*

Parent's Email Address*

Player Name*

First Name Last Name

Player's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Player's Birth Date*

Gender

Where are your people from?

With which racial and ethnic group(s) do you identify? (Mark all that Apply)

American Indian or Alaska Native
Asian
Black or African American
Hispanic, Latinx, or Spanish origin
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Another race or ethnicity not listed above
Don't wish to answer

With which racial and ethnic group(s) do you identify?

Additional Child

Name	Age	Gender	School/Grade

How did you find out about Play Where You Stay?

If a friend told you about Play Where You Stay, tell us there name so we can thank them.

Player Shirt Size **

School*

Grade Level*

Does your player(s) have any allergies or medical conditions we need to know about to keep them safe?*

We are so glad you've chosen to play soccer with Play Where You Stay!*

Tell us where you want to play.

Binghampton Park, 2606 Everett Ave, 38122 Monday – Friday, 4:00-5:00
Chandler Park, 979 Walker Ave, 38106 Monday, Wednesday, Friday, 4:00-5:00
Treadwell Park, Given Ave. 38122, Monday - Friday, 3:30 - 4:45
Klondike Park, 1201 Browne Ave, 38107 Monday – Thursday, 3:30-4:30
Early Maxwell Field, 2452 Central Ave, Monday - Thursday, 4pm - 5pm
Parkway Village, 4450 Knight Arnold Road, 38118 with Memphis Athletic Ministries, Olivet, Monday, Thursday 4:00pm - 5:00pm

Tell us what days you plan to play.*

Monday
Tuesday
Wednesday
Thursday
Friday

With the support of Play Where You Stay coaches, your player can join in on Saturday games at the Midtown, Greenfield location.

Check here if you'd like to play.

Saturday Games

Anything Else you'd like to share about your player? Tell us here.

How long have you played soccer?*

Never but I love playing!
Since I could kick a ball
In the last two years

Where have you played soccer?

church or other recreational league
in the park
in the street
in my backyard
on a competitive club team
at recess

If you played for an organized team, tell us about that!

How will your player arrive to and from the field (check all that may apply):*

Walk, Run, Walk while juggling a soccer ball
Bike, Scooter, Roller Skate
Ride in a car with a parent/guardian
Ride in a car with someone else

In case you're busy and your child needs someone, please give us the name and number of another adult they know well*

First Last

Emergency Contact Phone*

If you have a doctor you go to tell us their name and number

First Last

Doctor's Phone

Just in case, do you have a preferred Hospital?

Opt-Out Photograph Release Form

Play Where You Stay takes photographs/video of students and staff for the purpose of promoting Play Where You Stay. This questions allows participants/guardians the option to not allow Play Where You Stay to take photographs/video. Failure to exercise this option, releases and discharges Play Where You Stay from any and all claims arising out of the use of photographs/video, or any right that the parent(s) or minor(s) may have.

Check the first option ONLY if you DO NOT wish to give permission for Play Where You Stay to take photographs/video of me/the minor(s) named above or photographs/video in which I/the minor(s) may be involved with others for the purpose of promoting Play Where You Stay.

I DO NOT give Play Where You Stay permission
I DO give Play Where You Stay permission

PARENT/GUARDIAN CONSENT*

Recognizing the possibility of injury or illness, accepting my son(s)/daughter(s) as a player in this soccer program, I consent to my son(s)/daughter(s) participating in the Play Where You Stay soccer program. Further, I hereby release, discharge, and otherwise indemnify Play Where You Stay, its related entities, sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the program, against any claim by or on behalf of my player son(s)/daughter(s) as a result of my son(s)/daughter(s) participation in the program and/or being transported to or from the programs. I hereby authorize the transportation of my son(s)/daughter(s) to or from the program. I give my consent to have a coach and/or licensed medical doctor or dentist provide my son(s)/daughter(s) with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment. I understand the program runs between the hours of 3:30pm-5:15pm each weekday on school days. I accept the responsibility to have have my children walk home or receive a ride home at the end of the program between 4:30pm-5:15pm each day it is offered.

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

First Name Last Name

Play Where You Stay Monday - Friday Play

Pay in full by August 15th and get two weeks free!

Weekly: $10
9 Weeks: $90 ON SALE for $70
Pay at the Field

Number of children

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Today's Date*

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Total

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