PWYS Academy Registration – Play Where You Stay

We use this information for emergency contact or in the event of session cancelations.

Responsible Party 1(Required)

First Name Last Name

Responsible Party 1 Phone Number(Required)

Responsible Party 1 Email Address(Required)

Responsible Party 2

First Name Last Name

Responsible Party 2 Phone Number

Responsible Party 2 Email Address

Player Name(Required)

First Name Last Name

Player's Zip(Required)

ZIP Code

Player's Birth Year(Required)

Gender(Required)

Would you be interested in becoming a parent coach?

Yes

Payment Options

Pay in Full $150 + Convenience Fee

Pay in 2 Monthly Installments of $75 each month + Convenience Fee

Pay Cash

Total Due Today

Price:

Total Due Today - Monthly

Price:

Credit Card

CAPTCHA

Does your player(s) have any allergies or medical conditions?

Opt-Out Photograph Release Form(Required)

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(Required)

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 accept the responsibility to have have my children walk home or receive a ride home at the end of the program. 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

Where do you go to school?(Required)

What is your racial and ethnic identify? (Mark all that apply)(Required)

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

This information will not be used by or shared with PWYS coaches, partners, or participants. In order to keep PWYS affordable, we seek charitable grants from Foundations, which often require anonymized demographic information about the people we serve.

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