Registration Form

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Lapel Area Soccer Registration Form

Paid $________ Check #_______ Cash________

Make Checks payable to Trinity UMC

Please Read Registration Form and Fill Out Completely

Please fill out completely before returning. Full payment must accompany all registrations. If there are special circumstances that need to be considered, please attach an explanation to the registration sheet, i.e.: medical related, hardships, siblings, etc, All registrations should be in on April 19th when we assign the teams.

If you have any questions, contact Dawn Cuthbert at 534-4222 pastrdawn@aol.com or Julie DeMers at 534-3797 coachjulie12@hotmail.com.

PLAYER INFORMATION

Last Name____________________ First Name _______________Nick Name____________

Address___________________________________________ City______________________

Telephone
State______ Zip Code________ Area Code_____ Number____________________________

Age____________ Birthdate________________ M_____ F___________________________

T-Shirt Size: Youth XS ___Youth S ____Youth M ____Youth L____
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Father's Name________________________________ E-Mail_________________________

Business Phone______________________ Cell Phone_______________________________

Mother's Name________________________________ E-Mail_________________________

Business Phone______________________ Cell Phone_______________________________

List any medical problem or prohibition player has____________________________________

Person to notify in emergency, if parents are not available:

__________________________________ Phone__________________________________

Doctor to notify in emergency:___________________________________________________

Team Pictures will be taken on September 15th. We hope all team members will be able to attend.

IMPORTANT – PLEASE FILL OUT AND RETURN WITH REGISTRATION FORM

I, the parent / guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Lapel Area Soccer Program, its affiliated organization and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the Lapel Area Soccer Program accepting the registrant for its soccer programs and activities (the "Programs"). I hereby release, discharge, and or otherwise indemnify the Lapel Area Soccer Program, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs and / or being transported to or from the same which transportation I hereby authorize.

Parent / Legal Guardian
Name (Please Print)________________________ Signature_________________________ Date________________

Consent For Medical Treatment (Minor)

As the parent / legal guardian of the above named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions necessary to preserve the life, limb or well being of my dependent.

Signature of
Parent / Legal Guardian________________________________ Address____________________________________

Phone: Home______________________ Business__________________________ Date_______________________

Please attach check, cash, money order to each registration. It is OK to combine totals for more than one registration. Also --- Please fill out volunteer forms to help our kids!

Volunteers Are Needed

We hope parents/ guardians will actively participate in the soccer program. Please check the areas you would be willing to help with.

[ ] – Coach T-Shirt Size Adult__________