HOPATCONG HAWKS SOCCER CLUB

P.O. Box 629, Hopatcong, NJ 07843

REGISTRATION FORM- Traveling Team Soccer

PLAYER INFORMATION

 

Last Name__________________________First Name_________________________ MI______

 

Address_______________________________City__________________State_____Zip_______

 

Birthdate ___/___/___Gender: (Circle One)  M F Grade in Sp___/Fa___Tel No.______________

                                 

Uniform Sizes (Circle One): YS   YM  YL   AS   AM   AL  “HAS”   “NEEDS NEW”

 

Team (exp. U13B/U13G/etc.)  ­­­______              Coach’s Last Name  ________________________

 

Please list any medical conditions or allergies_________________________________________

 

Seasons Played _______  Level of Play (Circle the ones that apply): Recreation/ Travel/ Premier

PARENT/ GUARDIAN INFORMATION & WAVER:

 

Father’s Name_______________________________ Occupation_________________________

Mother’s Name______________________________ Occupation__________________________

 

Home Tel No. ______________ Alternate Tel No. ________________ E-mail_______________

 

Emergency Contact ______________________________ Tel No. _________________________

All primary insurance claims will be made to my insurance company:

 

Name of Insurance Co.______________________________ Policy No.____________________

The Hopatcong Hawks Soccer Club is a volunteer organization and we need your help. Please circle any categories listed below in which you would like to volunteer. COACHING (List any licenses possessed and/or experience) _______________________________ (No experience is necessary to become a coach. We will provide guidance and training) FUNDRAISING        AUXILLIARY COMMITTEE   FIELD COMMITTEE   CONCESSIONS   LIST OTHER WAYS YOU CAN HELP_____________________________________________

 

 

 

 

 

 

I, the parent/ guardian of the registrant, a minor, hereby give my approval to his/her participation in any and all Hopatcong Hawks Soccer Club activities during the current season. Recognizing the possibility of physical injury associated with soccer and in consideration for the Hopatcong Hawks accepting the registrant for its soccer programs and activities (the “Programs”), I hereby wave, release, absolve, discharge and/or otherwise indemnify the Hopatcong Hawks Soccer Club, the organizers, sponsors, supervisors, trainers, coaches, participants, associated personnel, including the owners of fields and facilities utilized for the programs, and person transporting my son/daughter to or from the programs from any claim by of on behalf of the registrant as a result of the registrant’s participation in the programs.

 

___________________________________  ________________________________  _________________

Print Name of Parent/ Legal Guardian            Signature of Parent/ Legal Guardian        Date

Do not write below. For Club use only.

Amount Paid____________ Check No._____________ Accepted by______________