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Player Information:

Team

Player Gender

Player Name

First

Last

Player Date Of Birth

Player Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Parent/Guardian Information:

Parent/Guardian Name

First

Last

Same as Player

Yes, use Player's address

Parent/Guardian Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian Email

Parent/Guardian Phone

Parent/Guardian Relationship to player

Emergency Contact Information:

Emergency Contact Same as Parent/Guardian?

Yes, use my Parent/Guardian info for Emergency Contact

Emergency Contact Name

First

Last

Emergency Contact Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Emergency Contact Relationship to player (copy)

Medical Information:

Allergies

Existing Medical Condition

Gender Player Soccer

Primary Care Doctor/Organization Name

Phone Number

Insurance Information

Consent and Waivers:

Medical Treatment Authorization

Liability Waiver/Release

Consent for Participation

Code of Conduct Agreement

I have read and agree to the FBI Academy Code of Conduct, for myself and my child.

FBI Academy Code of Conduct. FBI Academy builds players and people. Consistent with Article XII (Codes of Ethics) of the FBI Academy Bylaws, everyone in our program (players, parents/guardians, coaches and staff) is expected to practice honesty, integrity and respect, and to comply with all applicable laws and club policies.

Players: respect coaches, teammates, opponents, referees and facilities; follow coaches' instructions; arrive on time and ready to train; no bullying, harassment, fighting, discriminatory language, or use of tobacco, vaping, alcohol or drugs.

Parents/Guardians: support all players positively; do not yell at, or argue with, referees, coaches or players; leave coaching to the coaches during games and practices; raise concerns privately with the coach, or the Executive Director if needed, after a 24-hour waiting period, never on the sideline or on social media; no abusive language, threats or harassment of anyone.

Coaches and staff: model respect and sportsmanship, treat every player fairly, hold and maintain the required US Soccer coaching licenses, and never use abusive language, humiliation or physical punishment.

Nondiscrimination: in accordance with Section 8.04 of the Bylaws, FBI Academy does not discriminate on the basis of age, sex, race, religion, national origin or sexual orientation, and expects the same of every member of our community.

Reporting concerns (Bylaws Article XII): any suspected violation of this code, club policy or the law may be reported in writing to the Vice President or the Board President, and may be submitted confidentially or anonymously. Reports must be made in good faith; knowingly false or malicious reports are subject to review. The club will acknowledge each report within five business days, the Board (or its appointed committee) will promptly investigate, and appropriate corrective action will be taken. FBI Academy prohibits retaliation against anyone who reports a concern in good faith.

Discipline: violations may result in a warning, a meeting, a conduct agreement, suspension, or removal from the program without refund. Serious matters are reviewed by the Executive Director and the Board of Directors, and a decision may be appealed to the Board.

Additional Information:

Previous Soccer Experience

Preferred Position

Player Information:

Parent/Guardian Information:

Emergency Contact Information:

Medical Information:

Consent and Waivers:

Additional Information:

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Player Information:

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Emergency Contact Information:

Medical Information:

Consent and Waivers:

Additional Information:

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