Type Full Name :
Sign With Hand
Last Name
Parent/Guardian Details
If Yes, Please Explain:
Phone #
Certification

Registration Deadline:  February 15

($25 LATE FEE APPLIES)


**All players need to be registered


REGISTRATION FOR CUYAHOGA HEIGHTS VILLAGE RESIDENTS ONLY

Required Attachments
Birthdate
Position
I Have Read And Understand The Above Waiver And Release
Spring Soccer Application
Gender
Email
Shirt Size
Volunteer Registration
First Name
Participant/Child Details
Applicant/Parent/Guardian Email
Application Fees
Grade
Please List Any Conflicts Your Child May Have During The Season (i.e. another activity on Mondays, etc):
Do You Have Hospitalization And/or Medical Insurance?
ZIP
Name
Parent/Guardian Signature
Name
Late Fee
Phone #
Are you a Resident of Cuyahoga Heights?
Having been informed of the organization of the Cuyahoga Heights Recreation Department to provide supervised Youth Soccer, I/We the parents of the above named candidate, do hereby give my/our approval of his/her participation in any and all of the activities during the current season. I/We do assume all the risks and hazards incidental to the conduct of the activities, transportation to and from the activities, and I/We do further hereby release, absolve, indemnify and hold harmless the Village of Cuyahoga Heights, the organizers, sponsors, leasers and the supervisors appointed by them. I/We likewise release from responsibility any person transporting my/our child to or from activities. The Village of Cuyahoga Heights does not provide medical insurance.
Notes
By signing below, I the owner certify that all of the information provided in this application is true and accurate:
Recreation Department
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Does Your Child Have Any Physical Ailments, Such As Allergies, Heart Conditions, etc.?
Phone #
Address 2
Emergency Contact Information
Sizes
*Proof of residency (utility bill, tax statement, etc)
Address
If our Village is unable to form a team, please list your preferred village/team

*Please note: Teams are filled based on roster needs and guidelines. Therefore, your preferred request will be considered, but is not guaranteed.

Name/Relation
Shorts Size
City
State