What are you registering for
---One on One TrainingGroup TrainingTeam TrainingTeam CampWexford Camp: June 19-22 (HALF DAY)West Mifflin Camp: June 19-22 (HALF DAY)Northmoreland Camp: June 26-29 (HALF DAY)Ringgold Camp: June 26-29 (HALF DAY)Jefferson Hills Camp: July 10-13 (FULL DAY)Jefferson Hills Camp: July 10-13 (HALF DAY)South Park Camp: July 24-27 (FULL DAY)South Park Camp: July 24-27 (HALF DAY)
Athlete's First Name
Athlete's Last Name
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Cell Phone
T shirt size
---Youth MediumYouth LargeSmallMediumLargeXL
---Check (send to PO Box 18356, Pittsburgh, PA 15236)PayPalCredit Card (Invoiced through Paypal)Other
How Did You Hear About Us
---Friend (please specify in comment box below)Organization (please specify in comment box below)FlyerEmailInternet SearchOther (please specify in comment box below)
Comments / Special Requests / Medical Issues / etc.
Terms and Conditions:
Hold Harmless, Indemnity and Release:
In consideration of my participation in these activities, I, for myself, spouse, heirs, personal representatives, estate or assigns, agree to defend, hold harmless, indemnify and release the Pittsburgh Soccer Academy, employees, agents, volunteers, and all others who are involved, from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, or personal injury, or death which may result from my participation in the above-listed program. This release includes claims based on the negligence of the Pittsburgh Soccer Academy and their,
employees, agents, and volunteers, but expressly does not include claims based on their intentional misconduct or gross negligence. I understand that by agreeing to this clause I am releasing claims and giving up substantial rights, including my right to sue.
I understand and give permission that all photographs and/or videos taken of the applicant during this event is the property of Pittsburgh Soccer Academy and may be used along with my child’s name in camp videos, broadcasts, publications and/or promotional media.
Consent for Emergency Treatment:
I authorize the Pittsburgh Soccer Academy and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon
the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization. By signing/clicking below I agree to everything stated in all of the above paragraphs: Assumption of Risks, Hold Harmless, Indemnity and Release, Media Release, and Consent for Emergency Treatment
Please Note and Abide by Code of Conduct and Zero Tolerance Policy:
Code of Conduct for Players:
To encourage good sportsmanship from fellow players, coaches, officials and parents at all times. To do the best I can each day, remember that all players have talents and weaknesses the same as I do. To treat my coaches, other players and coaches, game officials, other administrators, and fans with respect at all times: regardless of race, sex, creed, or ability, and I will expect to be treated accordingly. I will exercise self-control and control my temper, resisting the temptation of retaliation. To know and respect the rules of soccer and abide by them at all times. Show respect and courtesy to officials and coaches by following their instructions and direction. Respect the game officials and refrain from addressing them or commenting on their decisions during or after the game. Avoiding the use of abusive or profane language, taunting or humiliating remarks, and/or gestures and physical assault upon another player at any time. Respect the coaches and players of the opposing team and display sportsmanship at the conclusion of a game and be humble and generous to victory and courteous in defeat.
Zero Tolerance Policy:
To help prevent physical assault, verbal abuse, and unsportsmanlike conduct, PSA has adopted a ZERO TOLERANCE POLICY. This policy applies to all coaches, players, parents, spectators and other supporters and referees. Abusive and obscene language, violent play/conduct, fighting, bullying, and other behavior (including, but not limited to sarcasm, taunting, etc.) deemed detrimental to the game/practice/camp/event between the above mentioned groups will not be tolerated. This policy applies before, during and after any PSA event, at the soccer field and its immediate surrounding areas.
I accept the terms and conditions