fall 2017 & spring 2018
RIDGEFIELD PARK SOCCER ASSOCIATION REGISTRATION FORM - FALL 2017 & SPRING 2018 Registration Is Open To Boys And Girls, Pre K - 8th Grade, Born Between 10/1/2003 - 9/30/2013 Residing, or Attending School in, Ridgefield Park, Bogota, or Little Ferry
Online Registration Available by visiting us at www.rpsa.org NAME: ______________________________________________________________
NEW PLAYER: Y____ N____
FOR NEW PLAYERS - PREVIOUS SOCCER EXPERIENCE, IF ANY: _______________________________(Years) ADDRESS: ___________________________________________________________ CITY: ____________________________________________________
MALE _____ FEMALE _____
BIRTHDATE: _____/____/___________
PHONE (Home): ____________________________________ (Cell): _________________________________________ LIST ANY MEDICAL PROBLEM OR PROHIBITION PLAYER HAS: ______________________________________ SCHOOL: ____________________________________
GRADE AS OF SEPTEMBER
2017: _______________
FATHER:_____________________________________EMAIL: __________________________@___________________ MOTHER:____________________________________EMAIL: __________________________@___________________ IMPORTANT NOTES : 1. New players must provide a copy of their BIRTH CERTIFICATE upon submitting this form 2. Registration forms can be mailed to: RPSA - P.O. Box 315 Ridgefield Park, N.J. 07660 3. For any questions or inquiries email our registrar, Ricky Ramirez: [email protected] 4. LATE FEE – A late fee of $5.00 must be added to each registration form received after 6/15/2017 5. We cannot guarantee a spot on a team for any registrations RECEIVED after 6/30/2017
AUTHORIZATION TO PLAY I authorize my child to play youth soccer with the Ridgefield Park Soccer Assoc. (RPSA). I, one of the parents or guardians of the above named candidate, do hereby give my approval for my child’s participation in any and all soccer activities. I/We do release, absolve, and hold harmless the Ridgefield Park Soccer Assoc., and all others listed hereafter; organizers, officers, coaches, referees, supervisor, and land owners (permitting the use of their land for soccer activities), any and all of them. I further agree to abide by the rules, regulations, and decisions of RPSA, the RPSA officers, coaches or referees. In case of injury to my child, I waive all claims against organizers, sponsors or any supervisors appointed by them. I understand that RPSA enrolls players in a secondary insurance policy that carries a five-hundred-dollar ($500) deductible for which I am fully responsible.
_________________________________________________ Parent/Guardian Signature Date Fees Include FULL UNIFORM (Jersey, Shorts, and Socks). If paid in full by June 30th, you will receive a NY Red Bulls game ticket (restrictions apply) FEES: Please check boxes that apply [ ] $110.00 Full Year Registration [ ] $105.00 2nd Child, Full Year [ ] $105.00 3rd Child, Full Year [ ] $ 95.00 ½ year (No Disc) Fall Only [ ] Spring Only [ ] [ ] $ 5.00 Late Fee (Registrations received after 6/15/2017) [ ] Shin guards: Circle one: Junior $4.00; Intermediate $8.00; Large $8.00 [ ] Check here if shin guards delivered Total Amount Enclosed $________________ Make all checks payable to RPSA. Sorry, No Refunds
VOLUNTEERS NEEDED (Please Check): [ ] COACH
[ ] ASST. COACH
[ ] CONCESSION
[ ] REFEREE
[ ] PARENT / SUPV (Req. for 4-6 yrs)
RPSA is an all-volunteer organization dedicated to providing an enjoyable and rewarding experience to children and their families. RPSA receives no direct public funding and the success of our program is directly due to the hard work of volunteers. Participation of RPSA parents keeps our operational cost down, registration fees low, and is a benefit to all. Parents/Guardians of children registered in KK, Micro or Future Stars programs are required to volunteer for a min of 2 days to help supervise the children on the field. ________________________________________________________ Volunteer Name: Please Print Date
FOR OFFICIAL USE ONLY Player Fee: $____________ Cash [ ]
Check [ ]
Rec’d By _________________ DATE:_________________
Check #______________ Combined with __________________________________________
Online Registration Available by visiting us at www.rpsa.org NAME: ______________________________________________________________
NEW PLAYER: Y____ N____
FOR NEW PLAYERS - PREVIOUS SOCCER EXPERIENCE, IF ANY: _______________________________(Years) ADDRESS: ___________________________________________________________ CITY: ____________________________________________________
MALE _____ FEMALE _____
BIRTHDATE: _____/____/___________
PHONE (Home): ____________________________________ (Cell): _________________________________________ LIST ANY MEDICAL PROBLEM OR PROHIBITION PLAYER HAS: ______________________________________ SCHOOL: ____________________________________
GRADE AS OF SEPTEMBER
2017: _______________
FATHER:_____________________________________EMAIL: __________________________@___________________ MOTHER:____________________________________EMAIL: __________________________@___________________ IMPORTANT NOTES : 1. New players must provide a copy of their BIRTH CERTIFICATE upon submitting this form 2. Registration forms can be mailed to: RPSA - P.O. Box 315 Ridgefield Park, N.J. 07660 3. For any questions or inquiries email our registrar, Ricky Ramirez: [email protected] 4. LATE FEE – A late fee of $5.00 must be added to each registration form received after 6/15/2017 5. We cannot guarantee a spot on a team for any registrations RECEIVED after 6/30/2017
AUTHORIZATION TO PLAY I authorize my child to play youth soccer with the Ridgefield Park Soccer Assoc. (RPSA). I, one of the parents or guardians of the above named candidate, do hereby give my approval for my child’s participation in any and all soccer activities. I/We do release, absolve, and hold harmless the Ridgefield Park Soccer Assoc., and all others listed hereafter; organizers, officers, coaches, referees, supervisor, and land owners (permitting the use of their land for soccer activities), any and all of them. I further agree to abide by the rules, regulations, and decisions of RPSA, the RPSA officers, coaches or referees. In case of injury to my child, I waive all claims against organizers, sponsors or any supervisors appointed by them. I understand that RPSA enrolls players in a secondary insurance policy that carries a five-hundred-dollar ($500) deductible for which I am fully responsible.
_________________________________________________ Parent/Guardian Signature Date Fees Include FULL UNIFORM (Jersey, Shorts, and Socks). If paid in full by June 30th, you will receive a NY Red Bulls game ticket (restrictions apply) FEES: Please check boxes that apply [ ] $110.00 Full Year Registration [ ] $105.00 2nd Child, Full Year [ ] $105.00 3rd Child, Full Year [ ] $ 95.00 ½ year (No Disc) Fall Only [ ] Spring Only [ ] [ ] $ 5.00 Late Fee (Registrations received after 6/15/2017) [ ] Shin guards: Circle one: Junior $4.00; Intermediate $8.00; Large $8.00 [ ] Check here if shin guards delivered Total Amount Enclosed $________________ Make all checks payable to RPSA. Sorry, No Refunds
VOLUNTEERS NEEDED (Please Check): [ ] COACH
[ ] ASST. COACH
[ ] CONCESSION
[ ] REFEREE
[ ] PARENT / SUPV (Req. for 4-6 yrs)
RPSA is an all-volunteer organization dedicated to providing an enjoyable and rewarding experience to children and their families. RPSA receives no direct public funding and the success of our program is directly due to the hard work of volunteers. Participation of RPSA parents keeps our operational cost down, registration fees low, and is a benefit to all. Parents/Guardians of children registered in KK, Micro or Future Stars programs are required to volunteer for a min of 2 days to help supervise the children on the field. ________________________________________________________ Volunteer Name: Please Print Date
FOR OFFICIAL USE ONLY Player Fee: $____________ Cash [ ]
Check [ ]
Rec’d By _________________ DATE:_________________
Check #______________ Combined with __________________________________________
