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STORM Junior Academy 5-7 Years (U8)
Scholarships and Fee Reduction Program
Tryouts – U9 – U14
Tryouts – High School
Did someone on the STORM staff refer you? Please let us know!
Primary Contact Email
School Currently Attending
Current Grade Level
Player Date of Birth
Country of Birth
Country of Citizenship
Has player ever played outside the US?
Primary Language Spoken at Home
Player Jersey Size
Player Shorts Size
Player Sock Size
Please select one
Add Mother and Father
Add Mother Only
Add Father Only
Mother Home Phone
Mother Work/Cell Phone
Mother Email Address
Same as previous
Father Home Phone
Father Work/Cell Phone
Father Email Address
As parent/guardian, I release the above-named child to participate in the current Corvallis Soccer Club tryouts and all subsequent practices and games (if selected for the team). I release Corvallis Soccer Club and its agents from any liability for injury resulting from participation.
Liability Waiver: Parent/Guardian Name
Authorization for Emergency Medical Care (Waiver):
Name and phone number of person, other than parent or guardian, to contact and who is authorized to approve emergency medical treatment:
Emergency Contact Name
Emergency Contact Home Phone
Emergency Contact Cell Phone
Player's Family Doctor Phone
Player’s Family Dentist
Player's Family Dentist Phone
Family Health Insurance Co.
Policy ID No.
Group ID No.
Additional Medical Details
In the event that reasonable attempts are made to contact me/us at the above locations, or other person(s) designated above, but are unsuccessful, full authorization is given for: 1) the administration of any treatment deemed necessary by a licensed trainer, medical practitioner or team coach and 2) the transfer of my/our son/daughter or ward to any licensed hospital or emergency clinic reasonably accessible. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, to provide authority and power on the part of team coaches and aforementioned agent(s) to give reasonable care. Facts are given below concerning the player’s medical history that a medical practitioner should know.
Allergies to specific medications
Glasses or Contacts
False Teeth or Bridgework
Any previous significant medical problems
Any other relevant medical conditions
Date of last Tetanus Booster
Financial Obligation Agreement
If my child is offered a position on a CSC team, I agree to the following terms:
I will submit payment of fees at the start of each season, either in full or the first installment on a monthly of tri-annual payment plan. I understand that fees are non-refundable should my player leave the club mid-season and that refunds will only be granted on a case-by-case basis.
If I am applying for a need-based scholarship, I will submit the scholarship application, proof of eligibility paperwork, and a $100 deposit at the team formation meeting following tryouts. Scholarships will only be granted when all of the above have been received in a timely manner. In addition, I understand our family's portion of the fees not covered by the scholarship or deposit must be paid in full by 10/31/18.
I agree to uphold the CSC Financial Obligation Agreement
Yes, I Agree to uphold the CSC Financial Obligation Agreement
Code of Conduct
As the parent or legal guardian of the Corvallis Soccer Club player, I agree to uphold the values of CSC, and support the club by adhering to the following guidelines:
Code of Conduct
I agree to uphold CSC code of conduct
Yes, I Agree to uphold CSC code of conduct
Program Release of Liability
RELEASE OF ALL CLAIMS: I, the undersigned parent/guardian of the named minor registrant (hereinafter referred to as ‘Child’), agree that in consideration for my Child being allowed to participate in Corvallis Soccer Club (hereafter referred to as ‘CSC’), Oregon Premier League (hereafter referred to as ‘OPL’), and Oregon Youth Soccer Association (hereafter referred to as ‘OYSA’) soccer activities and programs (hereafter collectively referred to as ‘PROGRAMS’), we agree as follows: My Child and I release, waive, discharge and indemnify CSC, OPL, and OYSA from any and all liabilities, claims, demands or causes of action that may arise, by or on behalf of my Child, from or related to any loss, damage, permanent disability or injury, including death, sustained by my Child while participating in the PROGRAMS and/or while my Child is being transported to or from any PROGRAMS, which transportation I hereby authorize, and/or while my Child is participating in team activities including, but not limited to, social outings.This release, waiver, discharge and indemnification clause includes any claims for injury and death based on the negligence of CSC, OPL and OYSA, to the fullest extent permitted by law. My Child and I are fully aware of the risks connected with participation in the PROGRAMS. These risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of my Child, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials and monitors, and a lack of hydration. My Child and I have also received and read the Fact Sheet on Concussions. I, therefore, expressly assume all known and unknown risks and accept personal responsibility for maintaining the safety of my Child.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
I agree to the program release of liability
Yes, I Agree to the program release of liability
Authorization of Publicity
I hereby voluntarily and without compensation authorize visual images and/or voice recordings to be made of my child by, or on behalf of, Corvallis Soccer Club (hereafter referred to as ‘CSC’), and any other sponsoring entities during practices, games, tournaments and any other CSC sponsored events. I also authorize CSC, and any other sponsoring entities, to reproduce, modify, publicize, broadcast and display any such visual images or voice recordings of my child, with or without my child’s name included. I understand that any such reproduction, modification, broadcast or display can be made without notice to my child or me, and will be made without payment, royalty, fee or compensation to my child or me. Such reproduction, modification, broadcast or display includes, but is not limited to: All internet sites (including, but not limited to CSC homepage, YouTube, Facebook), Email and Email attachments, Newspapers, Magazines, Flyers, Radio, Television, Videotape Recordings, and DVD/CD Recordings. I hereby agree not to sue CSC or any other entity that is involved in the reproduction, modification, broadcast or display of such visual or voice recordings. I release all claims that I may have for invasion of privacy, right of publicity, defamation, copyright infringement, or any other cause of action arising out of the use, adaptation, reproduction, distribution, broadcast, or exhibition of my child’s likeness, name or voice.
I agree to the authorization of publicity
Yes, I Agree to the authorization of publicity
Name of Parent/Legal Guardian
Electronic Signature: Name of Parent/Legal Guardian
Pay Annual Registration Fee
Pay online or in person at the first day of tryouts. Note: $1 is added to online payments of the annual registration fee to help offset processing fees.
Pay Annual Registration Fee in Person
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