Online Registration for Andro United Youth Soccer

Andro United

Indoor Soccer Leagues

Winter 2021-2022 Registration

Soccer players can be registered in one of two ways:

Website - Register and Pay Online - After completing the registration information you will make a $104 payment. You can make this payment with a debit or credit card. The additional $4 helps us offset the fees for processing payment online. You will then need to email or mail a copy of the player's birth certificate (only required once per winter).

Mail - Complete this fillable PDF. SAVE the document to your computer in order to fill out the form. Once completed, please print and mail, following the instructions on the form.

Deadline for Session 1 registration is Friday October, 30 2021. A $100 refund will be granted if requested on or the registration deadline. No refunds will be granted after the registration deadline.

Andro United Soccer Programs

Step 1 of 5

The Session Schedule
The complete schedule for Session 1 will be emailed to participants on Tuesday, November2, 2021. The schedule is dependent on the number of registrations for each division. Each week is made of 1-hour blocks on Saturdays and generally consist of:
Age Division 1: Between 9:00am and 11:00am
Age Division 2: Between 10:00am and 12:00pm
Age Division 3: Between 12:00pm and 2:00pm
Please consider your availability for the corresponding range of times if you have other Saturday activities/commitments. We are unable to guarantee any player a specific time each week.
Choose Your Session
Select the Session*
You must register each participant, for each session separately.

Session 1: Saturdays, November 6 - December 18

Session 2: Saturdays, January 8 - February 19

Session 3: Saturdays, March 5 - April 16
PLAYER'S INFORMATION
Player's Full Name*
First Middle Last
Gender*

Male

Female
Player's Date of Birth*

Month
Day
Year
Player's Address*
Street Address Address Line 2 City State ZIP Code
Player's Email
(Typically only used with the older players in Division 3)

Shirt Size*
Select the appropriate size shirt for the player. Shirts are cotton and tend to shrink a little after washing/drying.

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large
Goalkeeping
Coaches will ask for goalkeeping volunteers each week. We think it's important to provide players an opportunity to play all positions. However, it would be helpful to know if a player WANTS to be a goalkeeper in an effort to avoid having 3 goalkeepers randomly placed on a single team, and no goalkeepers on another team.
Checking this box does not mean the player will only be goalkeeping. We want aspiring goalkeepers to have time playing field positions as well.
Player would enjoy being a goalkeeper
Club Name: Andro United
City: Leeds
State: ME
League Name: Androscoggin Youth Indoor Soccer
Do you agree*
I hereby consent to the above-named club registering me with US Club Soccer. I understand that I may be registered to only one US Club Soccer member club at any time. [Note: it will not be necessary to complete this form again as long as the player is with this club, which will hold this form unless requested by US Club Soccer.
Yes

PARENT OR GUARDIAN'S INFORMATION
Parent or Guardian's Full Name*
First Last
Parent or Guardian's Phone*
Parent or Guardian's Email*

Parent or Guardian's Address (if different than player's address)
Street Address Address Line 2 City State ZIP Code

Additional Parent or Guardian's Full Name
First Last
Additional Parent or Guardian's Phone
Additional Parent or Guardian's Email

EMERGENCY CONTACTS
In an emergency when parent/guardian cannot be reached, please contact the following:
Emergency Contact Person #1*
First Last
Emergency Contact Phone #1*
Emergency Contact Name #2
First Last
Emergency Contact Phone #2

MEDICAL & MEDIA INFORMATION
Please list player allergies
Please list other medical conditions
Physician's Name*

Physician's Phone*
Preferred Hospital*

Medical/Hospital Insurance Company*

Medical/Hospital Insurance Company Phone*
Policy Holder’s Name*
First Last
Policy Number*

Medical Agreement*
I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.
Yes
Media Agreement*
I hereby give my consent and consent on behalf of my child to be photographed/filmed while participating in Andro United run events and to use such photographs/footage for any purpose, including promotional advertising.
Yes
Signature*
Type your full name for official digital authorization.

Date*
MM slash DD slash YYYY

Relation to Player*

Mother

Father

Guardian
Payment Information*
Please DO NOT enter any spaces or dashes for the credit card number.

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Register Player Online Payment
Price:
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Comments
This field is for validation purposes and should be left unchanged.

Andro United Soccer Programs

Step 1 of 5

The Session Schedule

Choose Your Session

PLAYER'S INFORMATION

PARENT OR GUARDIAN'S INFORMATION

EMERGENCY CONTACTS

MEDICAL & MEDIA INFORMATION