South Brunswick Soccer Club - Club Travel Tryouts Registration Form

SBSC Club Travel Program
Tryout Registration Form
Fall 2010 Travel Teams

Player's Information:

* - Denotes required field


	*First Name:	*Last Name:

*Address:

*City:

*State:

*Zip Code:

*Phone: --

*Emergency Contact Phone #: --

*Date of Birth:
Select Month, Day and Year

*Grade In Fall 2010:

*Gender:

Current Team (*if applicable):

Parent's Information:

Mother's Name:

Father's Name:

*Parents' Primary E-mail Address:

MEDICAL RELEASE AND FINANCIAL TERMS

I HEREBY GIVE MY CHILD PERMISSION TO ATTEND THE SBSC TRYOUTS AND I AGREE NOT TO HOLD SBSC, ITS OFFICERS, COACHES AND TRAINERS RESPONSIBLE FOR ANY INJURIES SUSTAINED BY MY CHILD AS A RESULT OF SUCH PARTICIPATION. IN THE EVENT THAT I AM NOT PRESENT AT THE TIME OF AN INJURY TO MY CHILD, I AGREE THAT COACHES, TRAINERS OR OTHER ASSISTING PARENTS MAY SEEK EMERGENCY MEDICAL ASSISTANCE UNTIL I CAN BE REACHED.

I UNDERSTAND THAT ACCEPTANCE OF AN OFFER TO PLAY ON AN SBSC TRAVEL TEAM MUST BE MADE WITHIN 48 HOURS OF RECEIVING SUCH OFFER. I ALSO UNDERSTAND THAT THE SBSC TRAVEL REGISTRATION FEE MUST BE PAID IN FULL OR AN APPLICATION FOR FINANCIAL SCHOLARSHIP MUST BE SUBMITTED AS DETAILED IN THE OFFER.

If you read and agree with the MEDICAL RELEASE AND FINANCIAL TERMS above, click on the
I AGREE check box and enter your name and the date.

		I AGREE (Acts as Parent/Guardian Signature)
		NAME: DATE:

PLEASE REVIEW AND VERIFY ALL INFORMATION BEFORE CLICKING SUBMIT.
PLEASE CLICK SUBMIT ONLY ONCE. THANK YOU.

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.

South Brunswick, New Jersey
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SB Soccer Webmaster

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This Page Revised: Wednesday, April 14, 2010