Registration Form Registration Form

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Rosedale Soccer League

Mailing Address: Rosedale Soccer League P.O. Box 23328 Detroit, MI 48223-0328

www.rosedalesoccerleague.org 1-313-405-3314

Registration Fee Schedule Early Bird Registration Fee $85 until April 30th Regular Registration Fee $105 until June 30th Late Registration Fee $120 until July 31st Final Registration Fee $150 until August 25th

Registration Form Player’s Name: (As you want it to appear on the trophy) Gender:

☐ Male

☐ Female

Date of Birth:

Address:

Age (As of 8/11/18):

City:

Zip:

Primary Contact Name:

Primary Contact Phone #:

Primary Contact Email: Additional Contact Name:

Additional Contact Phone #:

Additional Contact Email:

☐ 4/5 ☐ 6/7 ☐ 8/9 ☐ 10/12 ☐ 13/17 I want my child to play in Age Group (pick one) (Players can “Play Up’ with older players for more challenge but are not allowed to “play back” with younger players.) Years of soccer experience:

School:

Special Requests: (NOTE: While RSL will attempt to honor requests for placement on a specific coach’s team or on a team with a specified player, RSL makes no express guarantee the request will be honored.) Please list any medical concerns that RSL should be aware of:

Registered Siblings (names): I will volunteer to help:

☐ Coach/Asst. Coach

☐ Field Preparation

☐ Referee

☐ Post-Game Clean Up

☐ Goal Post Setup/Take down

Release of Liability and Acknowledgement of Risk I agree to abide by the rules and regulations of the Rosedale Soccer League. I, the undersigned, acknowledge and confirm to be the parent or legal guardian of the child participating in this sport. I understand that the participation in and observation of this sport constitutes a risk to me and the child participating, including serious injury, or even permanent disability. I voluntarily and knowingly recognize, accept and assume this risk and release Rosedale Soccer League, North Rosedale Community House, their trustees, advisors, officers, sponsors, employees, officials, volunteers, and all involved persons from any liability therefore. I/We also hold harmless Rosedale Soccer League from any injuries or claims suffered at a related, but non-Rosedale Soccer League sponsored event.

Parent Signature

Date Registration Checklist FOR OFFICE USE ONLY DO NOT WRITE IN THIS BOX

Date Complete App Rec:

Rec. By:

Player’s Age Group:

☐ Full Uniform

☐Yes

Sibling Discount: Payment Made By: Additional Notes:

☐No

☐Yes

Size

☐No

☐Cash

Partial Reg. Fee

☐M/O

☐Yes

$

☐Credit Card

☐No

Uniform $

☐Check#

Jersey

☐Shorts Discount $

☐Socks

Size

Total Due

Amount Paid: $

$

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