Player's Name *

First Name

Last Name

Player's Birth Date *

This will help determine team placement

MM

DD

YYYY

Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian's Phone *

Country

(###)

###

####

Waiver *

By completing and submitting this form, I give permission to Imago Dei Soccer and its authorized representatives to contact my family regarding my child’s interest in participating in an organized soccer league. I understand that this contact may include communication about league opportunities, registration details, scheduling, fees, and other related information. I acknowledge that submitting this form does not constitute registration or a commitment to participate, but simply authorizes Imago Dei Soccer to reach out for informational purposes. All information provided will be kept confidential and used solely for communication related to the soccer program. By submitting this form, I affirm that I am the parent or legal guardian of the child named below and that my electronic submission serves as my signature of consent.

Yes