South Brunswick Soccer Club - Travel Registration Form

STEP
1 of 4

SBSC Travel Program - Registration Form
Fall 2010 Season

STEP
1 of 4

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*: --

Grade*: (FALL 2010)

School player attends*:

If other, please specify:

Please select the Travel Team that you have been selected to*:

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

Travel 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*:

Select Sock Size*:

Uniform sizes are collected for informational purpose only. All uniforms are orders separately through Soccer Stadium.

Volunteer Information:

I'd like to be a Coach.
I'd like to be an Assistant Coach.
I'd like to be a Team Manager.
I'd like to be a S.A.G.E. Representative.
I'd like to be on the Tournament Committee.
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 the SBSC travel program is a full year commitment and requires attendance at all games unless ill, injured or a major and unavoidable family event prevents us from doing so. I/We also commit to attending two practices per week through the fall and spring seasons.
	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.
	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.

There will be no refunds except for medical or extreme financial
circumstances to be approved by the SBSC Board.

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:
travel@sbsoccer.org

Privacy Statement
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, June 03, 2010