2018-2019 Talent ID

Lighthouse Soccer Club will be holding talent identification nights for the 2018-2019 soccer season. Please use the age chart for the proper time and location.

Players must wear shin guards, cleats & should bring a ball & water
Players should arrive 30 minutes before tryout to check-in

Please complete and submit the form below to send us your tryout registration. We'll be in touch shortly. Information sent through this form is protected with 256-bit SSL encryption.

Tryout Registration*
Price: $10.00
Player Information
First Player - Team/Coach*
Player's Name*
First Last
Player's Date Of Birth*
Player's Gender*
- Female
- Male
Player's School*
Does This Player Have Any Medical Issues?*
- No
- Yes
What Medical Issues Does This Player Have:*
Household Information
Parent / Guardian Name*
First Last
Household Address*
Street Address Address Line 2 City State ZIP Code
Parent / Guardian Primary Phone*
Parent / Guardian Secondary Phone*
Parent / Guardian Email*
Medical Insurance
Lighthouse Soccer Club requires that you disclose a primary medical insurance carrier. Failure to comply will disqualify applicant from participating in Lighthouse Soccer Club programs.
Insurance Company*
Policy Number*
Confirmation
Terms*
- I, the parent/guardian of the registrant, a minor, or adult registrant of legal age, agree that I and the registrant will abide by the rules of the EPYSA, it’s affiliated organizations and sponsors. Recognizing the possibility of the physical injury associated with soccer and in consideration for the EPYSA accepting the registrant for its soccer programs and activities (the “Programs”). I herby release, discharge and/or otherwise indemnify the EPYSA, its affiliated organizations, and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the Programs, against any claim by on or behalf of the registrant as a result of the registrant’s participation in the Programs, and/or being transported to or from the same, which transportation I herby authorized.
Signature
This form must be signed by a parent/guardian for minor player or by an adult player.
Total
ALL FEES MUST BE PAID ONLINE AT THE TIME OF REGISTRATION. When you submit this form, you will be taken to PayPal where your payment will be securely processed.

There is NO COST incurred by you for paying online. No credit card or PayPal information is stored on this site or seen by Lighthouse Soccer Club at anytime. Everything is processed securely by PayPal, who automatically encrypts your confidential information in transit from your computer to theirs using the Secure Sockets Layer protocol (SSL) with an encryption key length of 128-bits (commercial grade). Before you even register or log in to the PayPal site, their server checks that you're using an approved browser - one that uses SSL 3.0 or higher. For more information regarding the security of PayPal, please click here.
$0.00
Phone
This field is for validation purposes and should be left unchanged.

Player Information

Household Information

Medical Insurance

Confirmation