Netripper Futsal Club Player Registration - Match Team Player 2024-2025

    
1Complete Form

Option:  

Required  Price: 
Description: 
 = Required Field

 

 
 
 
 
  Select Month/Day/Year
 
 
 
 
 
Allergies or Medical Conditions 
 Medical Insurance Company Required
 Name of the Policy Holder Required
 Policy number Required
 Learning Needs or Special Concerns 
PARENT/GUARDIAN: Please type your name plus the last four digits of your SSN.
 Digital Signature for below approvals Required
 Today's Date (mm-dd-yy) Required


 Approvals

I, the parent/legal guardian of the above named player, a minor, hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well-being of my dependent.
I understand that I can cancel the registration before Nov 15th 2024 and receive a refund minus a $35 administrative fee.  After the registration deadline, no refunds will be given.
I understand that in addition to the Netripper Futsal Club player registration fee ($795), there is a separately paid USYF annual membership fee ($13.50) that each player must pay with United States Youth Futsal (USYF) yearly.

Players will not be eligible to participate in any USYF event, unless payment is received and released authorized.  Outdoor player registrations issued from US Club, AYSO, USYSA, State Associations. etc. are NOT valid for registration with USYF. (  - full instructions in the receipt email for Netripperfc   )
I, the parent/legal guardian of the above named player, a minor, recognize the possibility of physical injury associated with futsal/athlete training and in consideration for Netripper Futsal Club accepting the player, I hereby release, discharge and/or otherwise indemnify Netripper Futsal Club, its staff and other associated personnel, including owners of facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the program and/or being transported to or from the same, which transportation I hereby authorize. In addition, I hereby give my consent for the Netripper Futsal Club and Massachusetts Futsal Association to use the visual image of the player and/or concept for purposes that support the mission of the Netripper Futsal Club and Massachusetts Futsal Association. 

 CONTACT INFORMATION

GUARDIAN #1

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 
GUARDIAN #2 (optional)

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 

 Refund Policy

Thank you for registering.  You may cancel your registration before  Nov 5th 2024 and receive a refund of your fees minus a $35 administrative fee.  After the registration deadline, no refunds will be given.

Sincerely,

Soorena

--
Soorena Farboodmanesh
Registrar
Netripper FC
--
soorena@netripperfc.com
www.netripperfc.com
617-515-5998

 Contact Info