______________________ Full Time Program Soccer Camps Latest Headlines Testimonials Photo Gallery Events ______________________ Try Out Registration Form Please complete this registration form in full. All fields marked with * are required.Player Information First and Last Name:*FirstLast Date of Birth:*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Trying Out As:*Select valuePlayerKeeper Gender:*Select valueMaleFemale Address:* Street Address City State / Province / Region Postal / Zip Code Primary Phone No.* Email (Please note that this will be where your registration and other communications will be sent to):Parent/Guardian Information Name of Parent 1:* Cell Phone Number - Parent 1* Name of Parent 2: Cell Phone Number - Parent 2Additional Information Recommended to program by: Where did you hear about our program?*Select valueKids ClubBC Soccer WebBrochureSoccer TournamentWord of MouthOther District Player is In: Name of Current Soccer Club: Activity on other training days (fitness, other sports, etc): Does the player currently train with another soccer program other than his/her club team?*Select valueYesNo If yes, what current soccer program? In the past has the player trained with any other soccer program other than his/her club team?Select valueYesNo If yes, what previous soccer program? Other/Notes: Sign me up for your online e-mail list and keep me up to date on all upcoming eventsSelect valueYesNoLiability Waiver By indicating your acceptance you acknowledge the above-named registrant and the parents/guardians hereby agree that the European Soccer School of Excellence will not be held responsible for any accident or loss no matter how it is caused, and agree to release all instructors, staff or sponsors from all claims or damages which may arise as a result of/or by reason of such accident or loss.*I agree with the above statementImage Rights Waiver By indicating your acceptance you understand and agree that the Roman Tulis staff may take photographic or video images of the above-named registrant. You further grant the Roman Tulis School the right to use such image or likeness in all forms and media, in connection with promotion of our program, or the sport of soccer generally.*I agree with the above statementI do not agree with the above statement IMPORTANT: Before submitting this form, please verify that all information provided is correct and up-to-date.*I confirm that all entries on this form are correctSubmitReset