Player Workout Form

Loudoun United High School Program - Tryout Registration Form
(Boys 9th Grade)
TRYOUT #1
Date: Sunday, February 23, 2014
Time: 1:30pm – 3:00pm
Location: Leesburg Christian School - 21336 Evergreen Mills Road, Leesburg
TRYOUT #2
Date: Thursday, February 27, 2014
Time: 7:00pm – 8:30pm
Location: Douglass Community Center - 405 E. Market Street, Leesburg 20176
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(Boys 10th & 11th Grade - Girls 10th Grade)
Date: Sunday, March 2 (tryout #1) and March 9th (tryout #2)

Location: Loudoun Valley High School - 340 N Maple Ave, Purcellville, VA 20132

Boys 10th Grade @ 4:30 - 6:00pm

Boys 11th Grade @ 6:00 - 7:30pm

Girls 10th Grade @ 7:30 - 9:00pm

Tryout Registration Form

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

Gender *

Grade *

High School *

Height *

Weight *

How did you hear about Loudoun United? *

Other Information *

LOUDOUN UNITED MEDICAL & PHOTO/PROMOTIONAL RELEASE

As the parent/guardian of the registered child, I do hereby grant permission for him/her to participate in all activities of this sports program including being videotaped, photographed and having videotape and/or pictures used by Loudoun United as advertising/promotional material. I assume all risks and hazards incidental to such participation including transportation to and from such activities and do hereby release and waive any and all claims or actions for damage or injury of whatever kind against Loudoun United; contractors, instructors, staff, board members, volunteers and/or other participants arising from any activities of this sports program.

I further grant permission for emergency first aid to be given to this minor and for him/her to be taken to the emergency room of a nearby hospital in the event of serious injury. Permission is granted to the hospital and its staff to provide any treatment that a physician deems necessary for the well-being of this minor.

I agree to the above Medical & Photo/Promotional Release *

Yes

Submit