Deerfield Community Center

Spring Soccer League 2008

Registration Form

 

** Deadline is Friday, February 22, 2008 **

 

 

Player's Name                                                                   Grade               Age              Birthday                          

           

Did your child play in the Fall 2007 League (if yes, sign the bottom)                  Yes                No

 

Address                                                                               City                                       Zip                           

 

Medical Information (Allergies, Asthma, ect.)                                                                                                            

 

Parent/Guardian's Name                                                                                                                                    

 

Home Phone                                       Cell Phone                                      Email                                                

 

Jersey Size (if you did not play in fall 2007)                       Youth: 6/8, 10/12, 14/16, Adult: Sm, Med, Lg

 

Volunteer  (Please circle one)                                                                  

                                    Coach                                           Assistant Coach                   

 

Please provide us with your preferred contact information:                                                              

                                                                                             Volunteer’s Name

IMPORTANT

Please read and sign the following

I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Deerfield

Community Center (the "DCC"), its affiliated organizations and sponsors. Recognizing the possibility of physical

injury associated with youth programs (the "Programs") and in consideration for the DCC accepting the registrant for

its Programs and activities, I hereby release, discharge and/or otherwise indemnify the DCC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.

As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care given

under whatever conditions are necessary to preserve the life, limb or well being of my dependent.

 

                                                                                                                                                                                               

Printed Name of Parent/Legal Guardian

 

                                                                                                                                                                                               

Signature                                                                                                                                               Date                                       

 
Text Box: IMPORTANT Please read and sign the following I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Deerfield Community Center (the "DCC"), its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with youth programs (the "Programs") and in consideration for the DCC accepting the registrant for its Programs and activities, I hereby release, discharge and/or otherwise indemnify the DCC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.                                                                                                                                                                                                   Printed Name of Parent/Legal Guardian                                                                                                                                                                                                   Signature                                                                                                                                               Date                                               

Return form and Fees to:

Deerfield Community Center at 3 W Deerfield St. or mail to PO Box 404, Deerfield, WI 53531

Text Box: DCC OFFICIAL USE ONLY:   Player fee:                               $                              Added to Database   Late Fee:                  $                Total                       $                              Check #  

 

 

 


 

                                                                                    Make Checks payable to DCC

                                                                                                                                    Amount Owed

                                                                                   

                                                                                    My child played in the fall                       $30