Adaptive Soccer Player Registration FormPlayer InformationPlayer Full NamePlayer Date of BirthPlayer AgePlayer Gender– Select –MaleFemaleOtherPrefer not to sayParent/Guardian InformationParent/Guardian Full NameParent/Guardian Relationship to Player– Select –MotherFatherLegal GuardianOtherEmailPhoneCityEmergency ContactEmergency Contact NameEmergency Contact PhoneEmergency Contact RelationshipMedical InformationKnown Medical Conditions, Allergies, or MedicationsHealth Insurance Provider (optional)About Your ChildThe following questions help us match your child with the right volunteer buddy and create the best possible experience. All answers are confidential and shared only with the coaching staff and your child’s assigned buddy. You are welcome to share as much or as little as you are comfortable with. Does your child have a diagnosis you’d like us to be aware of?How does your child best communicate? Verbal speech Short phrases or single world Nonverbal (gestures, pointing) Augmentative communication device (AAC) Sign language OtherMore DetailsDoes your child have any sensory sensitivities?Are there specific triggers, behaviors, or situations we should be aware of?What does your child enjoy or respond well to?Has your child participated in organized sports or group activities before? Yes No BrieflyIs there anything else you’d like us to know?Will you (parent/guardian) typically be on-site during sessions? Yes No SometimesHow Did You Hear About Us? Cupertino FC website Social media School (teacher, counselor, or Special Ed coordinator) Therapist or clinic Another parents Community group (Nextdoor, WeChat) OtherLegal AgreementsI agree to the Adaptive Soccer Player Participation Agreement — including the assumption of risk, waiver and release of liability, and medical authorization sections contained within it. I acknowledge that I have received the Concussion Information Sheet and Sudden Cardiac Arrest Information Sheet. Photo/Media Consent: A) Full Consent (as described in the Photo/Media Release) B) Limited Consent — Internal Use Only (as described in the Photo/Media Release) C) No Consent — Do not photograph my childPhoto/Media Release I am the parent or legal guardian of the player named above and am authorized to submit this form. Parent/Guardian Full Legal Name (Electronic Signature)DateSubmit Form
