Fall 2019 Academy Player - Form Instructions

To obtain a signed Academy Player Membership Form via email from Cleburne Soccer Association, please fill out the form below. If all of your information is good to go, the Registrar will send you a signed Academy Player Membership Form within 24-72 business hours. Legible copies/images of Birth Certificates or Passports are required each time you register.

The cost to register is $30.00 per season. Please note that the Registration Process is NOT complete until you have received a signed Academy Player Membership Form via email from Cleburne Soccer Association. Missing or incorrect information will delay the processing of your registration. 

Player Information

JPG or PDF image of Birth Certificate or Passport.
LARGE jpg files are not compatible. Try converting your file to PDF

Parent/Guardian Information

Medical / Emergency Information

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Payment and Agreement ($30.00)

RECOGNIZING THE POSSIBILITY OF PHYSICAL INJURY ASSOCIATED WITH SOCCER PARTICIPATION AND IN CONSIDERATION FOR NORTH TEXAS STATE SOCCER ASSOCIATION, INC., UNITED STATES SOCCER FEDERATION, UNITED STATES YOUTH SOCCER ASSOCIATION, AND THEIR RESPECTIVE MEMBER AFFILIATES (THE “SOCCER PARTIES”) ACCEPTING THE REGISTRANT FOR ITS SOCCER PROGRAMS AND ACTIVITIES (THE “PROGRAMS”), I HEREBY RELEASE, DISCHARGE, AND/OR OTHERWISE INDEMNIFY THE “SOCCER PARTIES” AND THEIR SPONSORS, EMPLOYEES AND ASSOCIATED PERSONNEL, INCLUDING THE OWNERS OF FIELDS 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 “PROGAMS” AND/OR BEING TRANSPORTED TO OR FROM THE SAME, WHICH TRANSPORTATION I HEREBY AUTHORIZE. BY MY SIGNATURE BELOW, I CONFIRM THAT MY SON/DAUGHTER IS PHYSICALLY CAPABLE OF PARTICIPATING IN THE “PROGRAMS”. I HAVE NOTED ABOVE, ANY SPECIFIC ISSUE, CONDITION, OR AILMENT THAT MY CHILD HAS OR THAT MAY IMPACT MY CHILD’S PARTICIPATION IN THE PROGRAMS. I HEREBY GIVE CONSENT TO HAVE AN ATHLETIC TRAINER AND /OR DOCTOR OF MEDICINE OR DENTISTRY PROVIDE MY SON/DAUGHTER WITH MEDICAL ASSISTANCE AND/OR TREATMENT AND AGREE TO BE RESPONSIBLE FINANCIALLY FOR THE REASONABLE COST OF SUCH ASSISTANCE AND/OR TREATMENT.

I FURTHER GRANT THE “SOCCER PARTIES” THE RIGHT TO USE THE PLAYERS NAME, PICTURES AND OR LIKENESS IN PRINTED, BROADCAST AND OTHER MATERIAL CONCERNING THE “PROGRAMS”, PROVIDED SUCH USE IS RELATED TO THE PLAYERS STATUS AS A PARTICIPANT IN THE “PROGRAMS”.

By typing your FULL NAME here, you are certifying that the information you are submitting is true and correct
By choosing YES on the photo release, I further grant the “Soccer Parties” the right to use the players name, pictures and or likeness in printed, broadcast and other material concerning the “programs”, provided such use is related to the players status as a participant in the “programs”.