munster soccer club
MUNSTER SOCCER CLUB Travel Release Registration Form www.munstersoccer.com CHECK #___________AMOUNT $____________
$140.00 Registration Fee for NEW PLAYERS (Includes Jersey & Socks) (Please make check payable to Munster Soccer Club) $110.00 Registration Fee for RETURNING PLAYERS (Not Needing Jersey & Socks) PLEASE CHECK ALL THAT APPLY BELOW: RETURNING PLAYER: __________ NEW PLAYER: __________ BOY: __________ GIRL: ___________ PLAYER INFO: NAME: _______________________________________________________________________________ LAST NAME FIRST NAME MI BIRTHDATE: _____/_____/_____ ADDRESS: ________________________________________________ CITY: ___________________________________________STATE:____________ZIP:_________________ SCHOOL: ___________________________________ GRADE: ______ HOME PHONE: ________________ PARENTS/GUARDIAN INFO: MOM: ____________________________________________________ HEAD COACH ASSISTANT COACH FIRST NAME LAST NAME (CIRCLE IF INTERESTED IN ABOVE) EMAIL: _______________________________________________________________________________ (CIRCLE FOR PREFERRED EMAIL) CELL PHONE DAD: _____________________________________________________ HEAD COACH ASSISTANT COACH FIRST NAME LAST NAME (CIRCLE IF INTERESTED IN ABOVE) EMAIL: _______________________________________________________________________________ (CIRCLE FOR PREFERRED EMAIL) CELL PHONE THE UNDERSIGNED UNDERSTANDS THAT THE NORTHWEST INDIANA SOCCER ASSOCIATION OR ITS AFFILIATES ARE NOT RESPONSIBLE FOR ANY LOSS OR INJURY DURING GAMES, PRACTICES, OR ANY OTHER LEAGUE ACTIVITY, OR WHILE BEING TRANSPORTED TO AND FROM ACTIVITIES, GAMES, AND OR PRACTICES. AS THE PARENT OR LEAGAL GUARDIAN OF ABOVE NAMED PLAYER, HEREBY GIVE CONSENT TO PARTICIPATE IN LEAGUE ACTIVITIES. ________________________________________________________________________________________________________
PARENT OR GUARDIAN SIGNATURE
DATE
(CIRCLE ONE JERSEY SIZE BELOW IF NEEDING JERSEY ONLY) Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
$140.00 Registration Fee for NEW PLAYERS (Includes Jersey & Socks) (Please make check payable to Munster Soccer Club) $110.00 Registration Fee for RETURNING PLAYERS (Not Needing Jersey & Socks) PLEASE CHECK ALL THAT APPLY BELOW: RETURNING PLAYER: __________ NEW PLAYER: __________ BOY: __________ GIRL: ___________ PLAYER INFO: NAME: _______________________________________________________________________________ LAST NAME FIRST NAME MI BIRTHDATE: _____/_____/_____ ADDRESS: ________________________________________________ CITY: ___________________________________________STATE:____________ZIP:_________________ SCHOOL: ___________________________________ GRADE: ______ HOME PHONE: ________________ PARENTS/GUARDIAN INFO: MOM: ____________________________________________________ HEAD COACH ASSISTANT COACH FIRST NAME LAST NAME (CIRCLE IF INTERESTED IN ABOVE) EMAIL: _______________________________________________________________________________ (CIRCLE FOR PREFERRED EMAIL) CELL PHONE DAD: _____________________________________________________ HEAD COACH ASSISTANT COACH FIRST NAME LAST NAME (CIRCLE IF INTERESTED IN ABOVE) EMAIL: _______________________________________________________________________________ (CIRCLE FOR PREFERRED EMAIL) CELL PHONE THE UNDERSIGNED UNDERSTANDS THAT THE NORTHWEST INDIANA SOCCER ASSOCIATION OR ITS AFFILIATES ARE NOT RESPONSIBLE FOR ANY LOSS OR INJURY DURING GAMES, PRACTICES, OR ANY OTHER LEAGUE ACTIVITY, OR WHILE BEING TRANSPORTED TO AND FROM ACTIVITIES, GAMES, AND OR PRACTICES. AS THE PARENT OR LEAGAL GUARDIAN OF ABOVE NAMED PLAYER, HEREBY GIVE CONSENT TO PARTICIPATE IN LEAGUE ACTIVITIES. ________________________________________________________________________________________________________
PARENT OR GUARDIAN SIGNATURE
DATE
(CIRCLE ONE JERSEY SIZE BELOW IF NEEDING JERSEY ONLY) Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
