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Player's Full Name ?

Date of Birth ?

Current Club / Team ?

Parent/Guardian Name ?

Parent/Guardian Phone Number ?

Medical Conditions or Injuries (if any) ?

Electronic Signature:

Waiver and Consent I, the parent/guardian of the participant, hereby give permission for my child to take part in the PSA Canada tryouts. I understand that soccer involves physical activity and the risk of injury. I acknowledge that PSA Canada, its coaches, staff, or affiliates are not liable for any injury, illness, or accident that may occur during training or matches. I confirm my child is medically fit to participate. In the case of emergency, I authorize PSA Canada staff to seek medical treatment if I cannot be reached. I also grant PSA Canada the right to use photographs or video recordings of my child taken during tryouts for promotional and social media purpose.

I have read and agree to the terms and conditions above

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