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WINTER SEASON REGISTRATION
Register
Full Name
Age
Gender
Parents / Guardian (1) Full Name
Parents / Guardian (1) Mobile Phone
Parents / Guardian (1) Home Phone
Parents / Guardian (1) Work Phone
Parents / Guardian (1) Email
Parents / Guardian (1) Address
Parents / Guardian (2) Full Name
Parents / Guardian (2) Mobile Phone
Parents / Guardian (2) Home Phone
Parents / Guardian (2) Work Phone
Parents / Guardian (2) Email
Parents / Guardian (2) Address
Pediatrician Full Name
Preferred Hospital
Pediatrician Phone Number
MEDICAL HISTORY
(If answer to any of the following questions below is yes, please describe the problem and it's Implications for proper first aid treatment within the registration)
Does the player have any other medical conditions that we need to be aware of?
(IN AN EMERGENCY, WHEN PARENT/GUARDIAN CAN'T BE REACHED, PLEASE CONTACT THE FOLLOWING):
Emergency Contact Full Name
Emergency Contact Relationship to Participant
Emergency Contact Primary Phone
Emergency Contact Alternate Phone
PLAYER CONTRACT FORM
The registering player hereby agrees to abide by the conditions, bylaws and rules of Princeton City Soccer Club and agree that during this soccer year, I will not play with or tryout for another soccer team unless I first obtain a release from this contract with Princeton City Soccer Club. I agree to take part in and uphold the duties and responsibilities of a player on this team, including attendance and participation at all regularly scheduled practices, scrimmages, games, tournaments and other club/team functions. I recognize that failure to live up to the spirit of these guidelines may result in disciplinary action. I agree to express myself in the true manner of good sportsmanship at all times.
PARENTS CONSENT / WAIVER
As the parent or legal guardian of the child named below, I hereby give my full consent and approval for my child to participate as a team member in the sport designated below. I understand that there are certain risks of injury inherent in the practice and play of this sport, as well as in traveling and other related activities incidental to my child's participation, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in the designated sport and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these activities, except as listed below. In addition to giving my full consent for my child's participation, I do hereby waive, release and hold harmless the organization named below, its officers, coaches, sponsors, supervisors and representatives for any injury that may be suffered by my child in the normal course of participation in the designated sport and the activities incidental thereto, whether the result of negligence or any other cause. I also grant Princeton City Soccer Club permission to take photographs and / or video of my child while participating in club activities. The photographs and videos will be used for Club promotion through any or all of the following formats: Website, flyers, brochures, newsletters, presentations, Facebook and other marketing activities.
Name of Child
Age
Gender
(Parent/guardian Name)
Date
(Please list any physical limitation - Allergies, Hearing, Sight, etc.)
PROCEED TO MAKE PAYMENT
Register
Full Name
Age
Gender
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Parents / Guardian (1) Full Name
Parents / Guardian (1) Mobile Phone
Parents / Guardian (1) Home Phone
Parents / Guardian (1) Work Phone
Parents / Guardian (1) Email
Parents / Guardian (1) Address
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Parents / Guardian (2) Full Name
Parents / Guardian (2) Mobile Phone
Parents / Guardian (2) Home Phone
Parents / Guardian (2) Work Phone
Parents / Guardian (2) Email
Parents / Guardian (2) Address
--------
Pediatrician Full Name
Preferred Hospital
Pediatrician Phone Number
--------
HEADING
Does the player have any allergies that we need to be aware of?
Does the player have any other medical conditions that we need to be aware of?
--------
(IN AN EMERGENCY, WHEN PARENT/GUARDIAN CAN'T BE REACHED, PLEASE CONTACT THE FOLLOWING):
Emergency Contact Full Name
Emergency Contact Relationship to Participant
Emergency Contact Primary Phone
Emergency Contact Alternate Phone
--------
PLAYER CONTRACT FORM
Signature
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PARENTS CONSENT / WAIVER
Name of Child
Age
Signature
Date
ny Disability?
PROCEED TO MAKE PAYMENT
