South Brunswick Soccer Club - In-Town Registration Form

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SBSC In-Town Program - Registration Form
Fall 2008 Season

STEP
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Player's Information:

* - Denotes required field

First Name*:

MI:

Last Name*:

Gender*:

Birth Date*: Select Month/Day/Year

Street Address*:

City*:

State*:

Zip Code*:

Home Phone*: --

School player attends*:

If other, please specify:

Grade*: (2008-09)

Is Player on Travel or School Team?* Yes No

Did you play in the SBSC In-Town Program in the Spring of 2008? * Yes No

If Female, do you want to play on an All Girls or Coed team? * All Girls Coed

Parent/Guardian Information:

Parent/Guardian #1:

First Name*:

Last Name*:

Relationship*:

Home Phone*: --

Work Phone: -- Ext.

Cell Phone: --

NOTE: Important notices are sent during the season via e-mail, please provide a primary contact
e-mail address that is checked regularly. E-mail address is used for SBSC announcements only and will not be shared or sold.

Primary Contact E-Mail*: Check If No E-Mail Address

Retype E-Mail Address to Verify*:

Parent/Guardian #2:

First Name:

Last Name:

Relationship:

Home Phone: --

Work Phone: -- Ext.

Cell Phone: --

Contact E-Mail:

Medical/Emergency Information:

Emergency Contact*:

Emergency Contact Phone*: --

Does player have any medical conditions?* Yes No

If Yes, please list:

Uniform Size Selection:

NOTE: Sizes listed for estimation purposes only

In-Town Uniform Sizes
Jersey	Shorts (waist)
Youth Small (6-8)	Youth Small (16"-18")
Youth Medium (10-12)	Youth Medium (20"-22")
Youth Large (14-16)	Youth Large (24"-26")
Adult Small (34-36)	Adult Small (28"-30")
Adult Medium (38-40)	Adult Medium (32"-34")
Adult Large (42-44)	Adult Large (36"-38")
Adult X-Large (46-48)	Adult X-Large (40"-42")
Adult XX-Large (50)

Select Jersey Size*:

Select Shorts Size*:

In-Town Player Fees:

Age Group	Fee
KinderSoccer	$75.00
Grade 1 Coed	$70.00
Grade 2-3 Girls	$70.00
Grade 2 Coed	$70.00
Grade 3 Coed	$70.00
Grade 4-5 Girls	$70.00
Grade 4 Coed	$70.00
Grade 5-6 Coed	$70.00
Grade 6-12 Girls	$70.00
Grade 7-12 Coed	$70.00

Notes:
The maximum cost will be $210.00 per family for the
In-Town Program when more than 3 players are registered in grades 1-12.

KinderSoccer is open to players who will be attending Kindergarten in Fall 2008.

KinderSoccer registration fee is Non-Refundable.

Special Request or Comments:

Special requests will be considered but ARE NOT GUARANTEED! Teams are formed NEW each season. Coaches will not receive the same team as the previous year. We try to insure that each player is with one or more players from their school or neighborhood.

Special Request or Comments:

Volunteer Information:

We will need approximately 120 Head Coaches this year. We will provide training and a mentor for anyone who wants to coach. NO EXPERIENCE IS REQUIRED.

I'd like to be a Coach.
I'd like to be an Assistant Coach.
I'd like to Volunteer in another capacity.
I do not wish to volunteer.

Donations:

Please selection the following options if you wish to make a donation toward equipment, field improvements or other club improvements. This amount will be added to your total amount due. At the end of registration you will receive a receipt on your certificate of registration.

$5.00 $10.00 $25.00 $50.00 $100.00 Other: $

I do not wish to contribute at this time.

Important Policy Information:

Read the following information and check each box to indicate your agreement.*
	I/We understand that a parent or guardian of my/our child must be present at all practices and games.
	I/We certify that my/our child, is in good health and is physically able to participate in all sports programs, consisting of practices and games, sponsored by this organization.
	I/We, the parent(s) and or guardian(s) of the above-named candidate for a position on a full sports program team, hereby give my/our approval of their participation in any and all activities during the current season.
	I/We assume all risks and hazards incidental in such participation, including transportation to and from the activities, and I/We do hereby waive, release, absolve, indemnify and agree to hold harmless the SBSC, the organizers, sponsors, participants and persons transporting my/our child to and from activities.
	I/We shall furnish a certified birth certificate of the above-named candidate upon request of officials.
	I/We agree to abide by the rules of good sportsmanship.
	I/We hereby give my/our permission for any medical attention necessary to be administered to my/our child in the event of an accident, injury, sickness, etc. This attention to be given under the direction of the persons listed above until such time as I may be contacted. I further authorize the coach, assistant coach, or any official of the SBSC in my absence and prior to the persons listed above being contacted to authorize immediate first aid to my child and emergency transport to the appropriate medical care facility. This release will remain in effect for the period of one year from the date registered. I also hereby assume the responsibility for payment of any such treatment and release SBSC and its officials from any and all liability or claims arising out of injury, accident or sickness to my/our child.
	Player information may be provided to a third party for insurance purposed only.
	I/We have read and fully support he principles of S.A.G.E.: My Pledge to Set A Good Example I will not be loud or negative towards players, referees, coaches or spectators. I acknowledge that failing to show respect for people who are doing the best they can sets a bad example for our children and can result in my expulsion from the field. If someone else makes an inappropriate comment, I will not make a negative response that could lead to a confrontation. I acknowledge that making mistakes and losing are part of life. I pledge that I will be tolerant of the mistakes of players, coaches, referees, and others. I recognize that mistakes are opportunities for learning. I recognize that within the parameters of competition, sportsmanship and fair play remain paramount. I pledge that I will commit to promoting and atmosphere of healthy competition to ensure fun for all following participants.
	I/We have read and understand the REFUND POLICY: LATE FEES ARE NOT REFUNDABLE. Refunds requested after 8/30/2008 will be subject to a $25 fee subtracted for processing costs. NO REFUNDS AFTER 9/12/2008.

PLEASE REVIEW ALL INFORMATION ENTERED FOR ACCURACY AND COMPLETENESS, BEFORE CLICKING SUBMIT.
PLEASE CLICK SUBMIT ONLY ONCE. THANK YOU.

If you need assistance, please send and e-mail to:
intown@sbsoccer.org

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The South Brunswick Soccer Club is the sole owner of the information collected on this form. We will not sell, share, rent, or give away this information to others in any way except where noted.

South Brunswick, New Jersey
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This Page Revised: Thursday, April 24, 2008