EmailMe Form - *2021 Registration Form*

CHILD'S Name: *
First Last
Gender: *
M
F
M = Male, F = Female
Child's Date of Birth: *
MM / DD / YYYY
BOYS BORN BEFORE JANUARY 2010 AND AFTER DECEMBER 2011 ARE NOT ELIGIBLE to participate this season.
Primary Phone: *
Enter phone number with area code and without dashes or brackets. Eg. 9995552222
Home/Street Address: *
City: *
State:
Zip Code *
Is this a new or returning WSA participant? *
NEW
Returning from 2020
Returning from 2019
Returning from 2018 or prior
Number of years this child has been playing soccer (in ANY league): *
Please name the soccer leagues this child has participated in:
On a scale of 1-5 (with 5 being the highest), rate this child's soccer skill level: *
1
2
3
4
5
PLEASE BE HONEST. Giving your child a high skill level will not automatically get your child in the league. WSA tries to balance teams based on skill level so an accurate rating is very important.
Did this child play competitive soccer in the past year or is this child already registered/committed to a competitive soccer team? *
NO
YES
WSA is a recreational program with some exceptions for competitive players. Note: Failure to disclose competitive participation will result in immediate removal from the program without a refund.
If this child has any disabilities, handicaps, present injuries or limitations, allergies, hemophilia, heart condition, history of respiratory illness or any other significant medical condition, please list them here:
Please list specific medical conditions and or restrictions and limitations in the above box.
Please select to indicate the parents/guardians on the child's birth certificate who are authorized to sign the registration form and make decisions for this child.

IF INFORMATION IS ONLY COMPLETED FOR ONE PARENT, ONLY THAT PARENT MAY SIGN THE REGISTRATION FORM AND MAKE DECISIONS FOR THIS CHILD'S PARTICIPATION IN THE LEAGUE.

**PLEASE CHECK BOTH BOXES AND COMPLETE INFORMATION IF BOTH PARENTS HAVE CUSTODIAL RIGHTS.** *
BOTH PARENTS--both parents (or two guardians) have custodial privileges.
Mother ONLY--By selecting this, ONLY the participant's Mother (or one guardian) may sign the registration form, medical release and concussion consent forms (which require a mandatory signature before participation).
Father ONLY--By selecting this, ONLY the participant's Father (or one guardian) may sign the registration form, medical release and concussion consent forms (which require a mandatory signature before participation).
Legal documentation must be provided to confirm legal guardianship.
I am confirming that I am the SOLE CUSTODIAL PARENT or LEGAL GUARDIAN of this child.

I am the ONLY individual authorized to sign this child's registration form and the medical release/concussion consent forms which will be distributed by the coach and requires a mandatory signature in order for this child to participate in practices and games. *
I agree
You cannot add another authorized individual after registration, unless the child's ORIGINAL birth certificate is presented to the WSA Registrar at a registration opportunity. If there is another individual with custodial privileges, please select "BOTH PARENTS" and complete the information.
FATHER's Name: *
First Last
Enter N/A if this child does not have a father or legal guardian.
Father's Business/Employer:
Father's Cell Phone: *
Enter phone number with area code and without dashes or brackets. Eg. 9995552222
Father's Email: *

Confirm
MOTHER'S Name: *
First Last
Enter N/A if this child does not have a mother or legal guardian. All contact information must be completed for at least one parent/legal guardian.
Mother's Business/Employer:
Mother's Cell Phone: *
Enter phone number with area code and without dashes or brackets. Eg. 9995552222
Mother's Email: *

Confirm
Emergency Contact (Name): *
Emergency Contact Phone Number: *
Enter phone number with area code and without dashes or brackets. Eg. 9995552222
How did you find out about Westchase Soccer Association? *
Other participants/parents
Flyer at Publix
Flyer at Westchase Rec. Center
Internet search
WOW Magazine
This is a returning participant (or sibling of a former participant)
Saw teams at Glencliff Park
Saw teams at the Rec. Center
Social Media
Other
Upload Original Birth Certificate
Original Birth Certificate MUST be brought to registration for all NEW participants and returning participants prior to 2018.

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