DUNAMIS FC – PLAYER REGISTRATION FORM

Fall 2025 Soccer Season – New York

PLAYER INFORMATION

Full Name

Date of Birth (MM/DD/YYYY)

Age Group

"U6""U7""U8""U9""U10""U11""U12""U13""U14+"

Gender

MaleFemale

School / Grade

Preferred Playing Position

PARENT / GUARDIAN INFORMATION

Parent / Guardian Name(s)

Relationship to Player

Address

City

State

ZIP Code

Phone Number

Email Address

EMERGENCY CONTACT

Emergency Contact Name

Relationship

Phone Number

MEDICAL INFORMATION

Doctor’s Name

Doctor’s Phone

Allergies / Medical Conditions

Current Medications

Insurance Provider

Policy Number

CONSENT & WAIVER

I, the undersigned parent/guardian, give permission for my child to participate in Dunamis FC programs.
I understand that participation in soccer involves physical activity and potential risk of injury.
I release Dunamis FC, its coaches, and staff from any liability related to injuries that may occur
during training, games, or events.

I agree to the consent and waiver stated above.

Photo / Video Permission

"I agree to allow photos/videos of my child to be used for Dunamis FC promotional purposes.""I do not agree."