2015 - 2016
Soccer Team
Tryouts
2015 - 2016 Soccer Team Tryouts
Registration and Consent Form
www.FCMirage.com
TEAM
U8 – U9 Boys
U8 – U9 Girls
U10 – U11 Boys
U10 – U11 Girls
U12 Boys
U8 – U9 Boys
U8 – U9 Girls
U12 Boys
U13 – U14 Boys
U10 – U11 Boys
U10 – U11 Girls
U13 - U14 Boys
DATE
Tuesday, May 26
Tuesday, May 26
Tuesday, May 26
Tuesday, May 26
Tuesday, May 26
Wednesday, May 27
Wednesday, May 27
Wednesday, May 27
Wednesday, May 27
Thursday, May 28
Thursday, May 28
Thursday, May 28
TIMES
4:00 pm - 5:00 pm
4:00 pm - 5:00 pm
5:00 pm - 6:30 pm
5:00 pm - 6:30 pm
6:30 pm - 8:00 pm
4:00 pm - 5:00 pm
4:00 pm - 5:00 pm
5:00 pm - 6:30 pm
6:30 pm - 8:00 pm
4:00 pm - 5:30 pm
4:00 pm - 5:30 pm
5:30 pm - 7:00 pm
Players should attend all scheduled tryouts
Location: F.C. Mirage Home Field located at South-Grove 1 at Harms Wood on the
corner of Golf Road and Harms Road in Glenview.
Directions: From 94(41) take the Old Orchard Rd. exit and head west to Harms Road.
Go south on Harms Road and before arriving at Golf Road, turn right on the South-Grove
1 entrance which is on the West side of Harms Rd.
Registration: To pre-register please visit www.FCMirage.com or fill out the
Registration and Consent Form and mail it along with a payment of $30, check or cash, to
the address below; Checks payable to FC Mirage. (F.C. Mirage T Shirt included)
Mailing Address: F.C. Mirage, 4457 W. Tucker Ln., Waukegan, IL. 60085
Tryout Results: Players will be notified, by e-mail, no later than Friday, May 29
SIGN UPS WILL BE AT THE F.C. MIRAGE HOME FIELD
ON SUNDAY, MAY 31st FROM 2:00 – 8:00 P.M
Player’s Name: ___________________________________________________________
Date of Birth: ________________ Gender: ⁫ M ⁫ F Phone: _____________________
Address: ________________________________________________________________
City: ________________________________ State:______ ZIP: _________________
Mother’s Name: __________________________ Cell Phone: _____________________
E-mail: _________________________________ Work Phone: ____________________
Father’s Name: ___________________________ Cell Phone: _____________________
E-mail: _________________________________ Work Phone: ____________________
Emergency Contact: ___________________________ Phone: _____________________
Previous Soccer Experience:
Positions Played: _______________________ Previous Clubs: ____________________
Does the player have any disabilities, handicaps, present injuries, or limitations, allergies,
hemophilia, heart condition, history of respiratory illness or any other significant medical
illness that might affect his or her participation in the sport of soccer?
⁫
NO ⁫ YES (if yes, please explain)
________________________________________________________________________
Participation Agreement and Liability Release
Consent and Release:
I acknowledge that soccer is a contact sport, which involves the possible risk of
injury. I consent to my child’s participation in F.C. Mirage (FCM) soccer program and
tryouts. I, individually, and on behalf of my child, do hereby release and forever
discharge FCM, its shareholders, officers, members, coaches, directors, agents and
representatives from any and all liability of whatever nature relating to or in any matter
arising out of my child’s participation in any and all programs offered by the FCM. I
agree to hold the FCM harmless and indemnify it for any damages, which may be
sustained in connection with our association or with participation in the FCM soccer
program. I understand that personal injuries can occur before, during, and after soccer
games or practices by reason of field preparation and conditions, equipment conditions,
and contact with participants, FCM personnel and spectators. This release shall apply to
any personal injury or other loss whether or not reasonably anticipated, expected, or
contemplated at this time. This release is indemnification shall be binding upon my
personal representatives, heirs and assigns.
___________________________________________
_____________________
Parent or Guardian Signature
Date
FOR MORE INFORMATION OR ANY QUESTIONS PLEASE CONTACT
E-mail:
[email protected]
Telephone: 847-732-1052