Spring 2017 Registration Form
PEMBERTON SOCCER CLUB PO Box 190, Browns Mills, NJ 08015 www.pembertonsoccerclub.com PAYMENT PLANS AVAILABLE - ONLINE REGISTRATION ONLY
FOR MORE INFO CALL OR TEXT: LYNDA, Gen. Sec. @ 472-6636; PEGGY, Pres. @ 346-7509; STEVE, VP Rec @ 251-7578 2017 SPRING RECREATION & TRAVEL FEES RECREATION FEE: AGES 3 & 4 YEAR OLDS $75 EACH - AGES 5-10: 1st Player $125 - AGES 11-13: 1st Player $100 - AGES 14-16: $75 EACH - Additional Player Discount: $15.00 - GAME SHIRT PROVIDED BY CLUB PAYMENT PLANS AVAILABLE THROUGH ONLINE REGISTRATION ONLY REGISTRATIONS RECEIVED BETWEEN 2/26/17 to 3/4/17 WILL BE CHARGED A LATE FEE OF $20 PER FAMILY SEE TRAVEL TEAM COACHES FOR UNIFORM COST FOR PLAYER IF REGISTRATION IS MIXED WITH TRAVEL & RECREATION PLEASE SEE BOARD MEMBER FOR TOTAL Military Discount $10.00 per child with proper ID- TO RECEIVE THIS DISCOUNT REGISTRATION MUST BE DONE IN PERSON ABSOLUTELY NO MORE PLAYERS WILL BE ACCEPTED OR ADDED AFTER 3/4/17
PLEASE NOTE: NEW PLAYERS MUST BRING THEIR BIRTH CERTIFICATE TO BE SEEN WITH THIS FORM PLEASE PRINT NEATLY / CLEARLY AS INFO IS NEEDED FOR COACHES TO CONTACT YOU TRAVEL
*CHILD’S NAME:
_____
team name:
*DOB:
*CURRENT AGE:
GENDER (CIRCLE):
RECREATION DIVISION (CIRCLE):
DIV 1
DIV 2
DIV 3
*BASED ON AGES (& POSSIBLE SKILL LEVEL)
AGES 3 & 4
AGES 5 & 6
AGES 7, 8
*UNIFORM SHIRT SIZE MUST BE CIRCLED:
YXS
*DID CHILD PLAY IN THE PAST SEASON? (CIRCLE) YES
DIV 4 AGES 9, 10
YS NO
YM
MALE
FEMALE
DIV 5
DIV 6
TRAVEL
AGES 11, 12 & 13
AGES 14, 15 & 16
ABOVE
YL
AS
*IF YES, AGE GROUP:
MICRO
AM
AL
MIDGET
AXL
JUNIOR
SENIOR TRAVEL
TEAM SHIRT COLOR:______ ________________________________
*PARENT/GUARDIAN NAME: _________________________________________________________________________________ *ADDRESS:_________________________________________________CITY/STATE/ZIP __________________________________ *HOME PHONE:_________________________*CELL PHONE:_______________________CELL PHONE: _____________________ **EMAIL ADDRESS MUST BE FILLED IN:_________________________________________________________________________ ADDITIONAL COMMENTS/REQUESTS: **PLEASE NOTE, ONCE YOUR CHILD IS PLACED ON A TEAM THEY WILL NOT BE SWITCHED TO ANOTHER TEAM UNLESS THERE IS AN ERROR ON PLACING A COACHS’ CHILD ON HIS/HER TEAM.** We can’t make any guarantees or promises on any requests. ABSOLUTELY NO REFUNDS AFTER COACHES RECEIVE THE ROSTERS. REFUND POLICY ON CLUB WEBSITE: pembertonsoccerclub.com MEDIA CONSENT: I hereby consent to the use of any photographs/video taken of my child that is deemed appropriate & approved by Pemberton Soccer Club (PSC) for the purpose of advertising or publicizing events, activities & programs of the PSC in newspapers, newsletters, websites, other publications, television, radio, & other communications & advertising media. Pemberton Soccer Club will never release personal information or print more than a first name in any publications. PLEASE CHECK ONE:
______YES, I GIVE PERMISSION
PARENT/GUARDIAN SIGNATURE:
______NO, I DO NOT GIVE PERMISSION ______________
DATE:
PARENT & SPECTATOR CONDUCT AGREEMENT: Parent & spectator conduct/actions during practices and games directly reflect the Pemberton Soccer Club board, coaches & players. Verbal or physical abuse & unsportsmanlike conduct of any kind directed at coaches, referees, players, other parents/spectators, etc. will not be tolerated. Refrain from instructing your child from the sideline during practices & games – leave this to the coaches. Absolutely no animals of any kind are permitted on the fields. Smoking is prohibited. Once child is placed on a team that will be the team for the current season NO SWITCHING.
ABSOLUTELY NO REFUNDS AFTER COACHES RECEIVE THE ROSTERS. REFUND POLICY ON CLUB WEBSITE: pembertonsoccerclub.com I have read the Parent & Spectator Conduct Agreement & understand the standards that are outlined referring to maintaining proper conduct at the soccer fields during games, practices & club functions. I understand that if I or any of my guests violates these standards, my child/children may be prohibited from playing with the Pemberton Soccer Club & I/my guests may be prohibited from attending practices, games, events, etc. I further understand that if my child is prohibited from playing due to my conduct or the conduct of my guests, no refund will be issued – no exceptions. PARENT/GUARDIAN SIGNATURE:
_____ DATE:
*HOW DID YOU HEAR ABOUT OUR PROGRAM? __________________________________________________________________________ 2017 SPRING SCHEDULE: START MARCH 25, OFF Easter weekend April 15 & 16, LAST GAME & END OF SEASON AWARDS MAY 20
FOR MORE INFO CALL OR TEXT: LYNDA, Gen. Sec. @ 472-6636; PEGGY, Pres. @ 346-7509; STEVE, VP Rec @ 251-7578 2017 SPRING RECREATION & TRAVEL FEES RECREATION FEE: AGES 3 & 4 YEAR OLDS $75 EACH - AGES 5-10: 1st Player $125 - AGES 11-13: 1st Player $100 - AGES 14-16: $75 EACH - Additional Player Discount: $15.00 - GAME SHIRT PROVIDED BY CLUB PAYMENT PLANS AVAILABLE THROUGH ONLINE REGISTRATION ONLY REGISTRATIONS RECEIVED BETWEEN 2/26/17 to 3/4/17 WILL BE CHARGED A LATE FEE OF $20 PER FAMILY SEE TRAVEL TEAM COACHES FOR UNIFORM COST FOR PLAYER IF REGISTRATION IS MIXED WITH TRAVEL & RECREATION PLEASE SEE BOARD MEMBER FOR TOTAL Military Discount $10.00 per child with proper ID- TO RECEIVE THIS DISCOUNT REGISTRATION MUST BE DONE IN PERSON ABSOLUTELY NO MORE PLAYERS WILL BE ACCEPTED OR ADDED AFTER 3/4/17
PLEASE NOTE: NEW PLAYERS MUST BRING THEIR BIRTH CERTIFICATE TO BE SEEN WITH THIS FORM PLEASE PRINT NEATLY / CLEARLY AS INFO IS NEEDED FOR COACHES TO CONTACT YOU TRAVEL
*CHILD’S NAME:
_____
team name:
*DOB:
*CURRENT AGE:
GENDER (CIRCLE):
RECREATION DIVISION (CIRCLE):
DIV 1
DIV 2
DIV 3
*BASED ON AGES (& POSSIBLE SKILL LEVEL)
AGES 3 & 4
AGES 5 & 6
AGES 7, 8
*UNIFORM SHIRT SIZE MUST BE CIRCLED:
YXS
*DID CHILD PLAY IN THE PAST SEASON? (CIRCLE) YES
DIV 4 AGES 9, 10
YS NO
YM
MALE
FEMALE
DIV 5
DIV 6
TRAVEL
AGES 11, 12 & 13
AGES 14, 15 & 16
ABOVE
YL
AS
*IF YES, AGE GROUP:
MICRO
AM
AL
MIDGET
AXL
JUNIOR
SENIOR TRAVEL
TEAM SHIRT COLOR:______ ________________________________
*PARENT/GUARDIAN NAME: _________________________________________________________________________________ *ADDRESS:_________________________________________________CITY/STATE/ZIP __________________________________ *HOME PHONE:_________________________*CELL PHONE:_______________________CELL PHONE: _____________________ **EMAIL ADDRESS MUST BE FILLED IN:_________________________________________________________________________ ADDITIONAL COMMENTS/REQUESTS: **PLEASE NOTE, ONCE YOUR CHILD IS PLACED ON A TEAM THEY WILL NOT BE SWITCHED TO ANOTHER TEAM UNLESS THERE IS AN ERROR ON PLACING A COACHS’ CHILD ON HIS/HER TEAM.** We can’t make any guarantees or promises on any requests. ABSOLUTELY NO REFUNDS AFTER COACHES RECEIVE THE ROSTERS. REFUND POLICY ON CLUB WEBSITE: pembertonsoccerclub.com MEDIA CONSENT: I hereby consent to the use of any photographs/video taken of my child that is deemed appropriate & approved by Pemberton Soccer Club (PSC) for the purpose of advertising or publicizing events, activities & programs of the PSC in newspapers, newsletters, websites, other publications, television, radio, & other communications & advertising media. Pemberton Soccer Club will never release personal information or print more than a first name in any publications. PLEASE CHECK ONE:
______YES, I GIVE PERMISSION
PARENT/GUARDIAN SIGNATURE:
______NO, I DO NOT GIVE PERMISSION ______________
DATE:
PARENT & SPECTATOR CONDUCT AGREEMENT: Parent & spectator conduct/actions during practices and games directly reflect the Pemberton Soccer Club board, coaches & players. Verbal or physical abuse & unsportsmanlike conduct of any kind directed at coaches, referees, players, other parents/spectators, etc. will not be tolerated. Refrain from instructing your child from the sideline during practices & games – leave this to the coaches. Absolutely no animals of any kind are permitted on the fields. Smoking is prohibited. Once child is placed on a team that will be the team for the current season NO SWITCHING.
ABSOLUTELY NO REFUNDS AFTER COACHES RECEIVE THE ROSTERS. REFUND POLICY ON CLUB WEBSITE: pembertonsoccerclub.com I have read the Parent & Spectator Conduct Agreement & understand the standards that are outlined referring to maintaining proper conduct at the soccer fields during games, practices & club functions. I understand that if I or any of my guests violates these standards, my child/children may be prohibited from playing with the Pemberton Soccer Club & I/my guests may be prohibited from attending practices, games, events, etc. I further understand that if my child is prohibited from playing due to my conduct or the conduct of my guests, no refund will be issued – no exceptions. PARENT/GUARDIAN SIGNATURE:
_____ DATE:
*HOW DID YOU HEAR ABOUT OUR PROGRAM? __________________________________________________________________________ 2017 SPRING SCHEDULE: START MARCH 25, OFF Easter weekend April 15 & 16, LAST GAME & END OF SEASON AWARDS MAY 20
