Clark Soccer Club
Fall 2014 Registration
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Parent First Name:
Parent Last Name:
Player First Name:
Player Last Name:
Grade (As of Sept 2014):
Does your child have any physical limitation that may limit their ability to run competitively for 20 to 90 minutes?
If Yes, Please Explain:
The success of the Clark Soccer Club would not be possible without the efforts of our volunteer coaches. The Club encourages
family members to join our coaching staff. No experience is necessary. The Club provides instruction for all coaches on
the general rules and fundamentals of the game as well as instruction on coaching youth sports.
Would someone in your family like to coach?
Coach First Name:
Coach Last Name:
Assistant First Name:
Assistant Last Name:
Do you know someone who would like to sponsor a team for the season? The sponsorship fee is $150.00 per team, per season.
I, as parent or legal guardian, do herby give my consent for my child to participate as a player in
the Clark Soccer Club. I understand and acknowledge that there are risks of personal injury in
soccer competition and in recognition of these risks do hereby release, hold harmless and
indemnify the Clark Soccer Club, its officers, directors, coaches and designated officials from all
claims, causes of action and any and all liability which may result, directly or indirectly, from my
I Give My Consent as Indicated above
Your registration can be paid online via Paypal using a Paypal Account / Credit Card or by personal check mailed to the club:
Payment type will be: