Moorestown Soccer Club - Registration Form

2008-2009 Registration Form

Complete and submit the information below. Use the "TAB" key to move between fields. PLEASE MAKE SURE YOU REGISTER ONLY ONCE PER CHILD.

* denotes a required field.

Player's First Name*: Player's Last Name*:
Home Address*:

City*:State*:Zip Code*:

Birth Date (MM/DD/YY)*: Gender*: Age Group*:

Grade as of Sept. 2008*: Player's Email:

Parent's First Name*:Parent's Last Name*:

Home Phone (000-000-0000)*: Work Phone (000-000-0000):

Email Address*:

MEDICAL RELEASE

I release and hold harmless the Moorestown Soccer Club, Inc. (MSC), the owners and operators of the facilities used for its soccer programs and their respective directors, officers, employees, agents and representatives from any and all liability to me or my child as a result of any MSC function/practice/game/transportation. Furthermore, my child is physically fit, except as noted below to participate in any and all soccer tryout activities. I hereby authorize the MSC to act for me in a medical emergency in the event I cannot be immediately contacted. This care may be given under whatever conditions are necessary to preserve life, limb, or well being of my dependent.

Known Medical Problems or Allergies:

By Submitting This Form You Agree To The Terms Of The Medical Release:
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