Clark Soccer Club - Registration

Clark Soccer Club

Spring 2013 Registration

Registration is open until 02/25/2013
Intown and Intercounty Registration is Now Closed

Personal Information

Parent First Name:		Parent Last Name:
Player First Name:		Player Last Name:
Street:
City:	Clark Garwood Winfield Other Zip:
Home Phone:		Cell Phone:
Birth Date:	(mm/dd/yyyy)		Gender: Male Female
School:		Grade (As of Feb 2013):
Email:

Program Information

Program:	Instructional ($50.00) In-Town ($80.00) Intercounty ($95.00) Intercounty With Uniform ($135.00)

Uniform Information

Shirt Size:		Short Size:

Additional Information

Does your child have any physical limitation that may limit their ability to run competitively for 20 to 90 minutes?
	Yes No
	If Yes, Please Explain:

Volunteer / Sponsor Information

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? Head Coach Assistant Coach No

Coach First Name:		Coach Last Name:
Coach Phone:

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. Yes No

Release

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 child’s participation.

I Give My Consent as Indicated above