Futsal San Jose - Registration for Futsal Academy Winter 2020/2021

Your password:

  Player Information  

*First Name:
Middle Initial:
*Last Name:
*Gender:
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip Code:
*Home Phone: --
*Birth Date (mm/dd/yyyy): / /
FUTSAL (Indoor Soccer) Experience:
Outdoor Soccer Experience:
*T-Shirt Size:
Team: If your team is registering please select it here:
or enter the team name here:
Friend Request: (No guarantee that we can take friend requests into account)

  Parent/Guardian Information 1  

*First Name:
*Last Name:
Work Phone: --   ext.
*Relationship:
*Enter E-mail for guardian:
*Verify E-mail by retyping:

  Parent/Guardian Information 2  

*First Name:
*Last Name:
Work Phone: --   ext.
*Relationship:
*Enter E-mail for guardian:
*Verify E-mail by retyping:

  Emergency Contact Information  

List any medical problems
or prohibitions the player has:
*Person to notify in emergency:
*Emergency Contact's Phone: --


  Important Policy Information  

*Read the following information and check each box to indicate your agreement.

As the Parent or Legal Guardian of the above name player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.
I, the parent/guardian of the registrant, a minor agree that I and the registrant will abide by the rules of Futsal San Jose, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with minisoccer and in consideration for Futsal San Jose accepting the registrant for its Futsal (5-A-SIDE/Minisoccer) programs and activities, I hereby release, discharge, and or indemnify Fustal San Jose and USFF, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of gymnasiums and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I authorize.


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