Tryout Registration

 

Please remember to send $25 non-refundable tryout fee to:
EIU
2011 Fox Trail Dr NE
Cedar Rapids, IA 52402

Player
  Last Name First Name Birth Date (mm/dd/yy) Gender  
   
  Street Address 1
  Street Address 2
  City ST ZIP
  Phone Number (###-###-####)
  eMail Address
  Team(s) Registering For  
Blue
Silver
White
  
    U18
 
    U17
 
 
Mother's Birth Date (mm/dd/yy) (note: This is required by the state as a portion of the player card number)
 
Parent/Guardian 1
  Last Name First Name      
         
 
Phone Number
Primary
Secondary
Other
 
(###-###-####)
 
Primary
Seconary
 
eMail Address
Parent/Guardian 2
  Last Name First Name      
         
 
Phone Number
Primary
Secondary
Other
 
(###-###-####)
 
Primary
Seconary
 
eMail Address
Waiver
  I, the parent or legal guardian of the above named individual, acknowledge that participation in athletic events necessarily involves risk of physical injury. I further acknowledge that the programs of the Eastern Iowa United are primarily administered by parents who volunteer their time rather than paid professionals. In consideration for accepting the registration of the above named individual and permitting the voluntary participation of said individual in its programs. I hereby release, discharge, and hold harmless Eastern Iowa United, its employees, volunteers and other representatives from any claims arising out of or relating to any physical injury that may result to said individual while participating in Eastern Iowa United sponsored events, including any physical injury caused by the negligence of any official, referee or coach while performing his/her duties during any practices or games.

 

Upon submission of this information you will receive a confirmation e-mail from the EIU Administrator. If you have not received an e-mail within 24 hours, please e-mail admin@easterniowaunited.org OR print the completed registration form and mail it in with the tryout fee check to the address listed.