Soccer Registration Form

NCSC Soccer Registration

Player Registration
You will need to fill out one registration per child. At the end of the regsitration form you will be taken to our payment portal. Once you have completed the regsitration and payment you can start a new registration form for the next child.
CHILD INFORMATION:
Child Name *

First Name Middle Name Last Name
Upload Current Player Picture *
Birth Date *

Month Day Year
Upload Birth Certificate *
Male/Female *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number *

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
Email *
example@example.com
Country of Birth *
Country of Citizenship *
Played outside of US *
If Yes, What Country
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name Mother *

First Name Last Name
Parent/Guardian Name Father *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number *

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
E-mail *
UNIFORM INFORMATION
Uniforms
You will be required to try on uniforms at the evaluation dates.
Evaluations
All players will be required to show up on their evaluation date.
Emergency Contact
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
MEDICAL INFORMATION
Physician Name

First Name Last Name
Phone Number

Area Code Phone Number
Medical Concerns
You may have to fill this out later
Insurance
Providers Name
Policy Holder
Policy Number
Phone Number

Area Code Phone Number
REGISTRATION PAYMENT
Parents with multiple children enrolled will be charged full price ($85) for the first registered child and receive a $5 discount for each child thereafter, up to three siblings.

There is also a one time per family $25 volunteer fee. This fee is refundable at the end of the season provided that you volunteer 4 hours at the field and it is logged by a board member.

Your child must be 5 years old born in 2015 to register.

You will need to provide a birth certificate for your child prior to collecting your uniform.
Parent Informed Consent
Player / Parent Contract
By submitting the form, I, as the parent/guardian of the registrant, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may given under whatever conditions are necessary to preserve the life, limb, or well-being of registrant.

By submitting the form, I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the NCSC, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the NCSC, accepting the registrant for its soccer programs and activities (the "Programs"). I hereby release, discharge and/or otherwise indemnify the NCSC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claimby 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.

By submitting the form, I, the parent/guardian of the registrant, a minor, agree to all the forms associated with this registration form. If needed later, I will fill out the forms in full to later time.
Signature

Clear

My Products

Soccer Registration - First Child $85 plus $25 Vol Fee $ 110.00

This fee includes the registration and volunteer fee.

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty:

NCSC Soccer Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

UNIFORM INFORMATION

Emergency Contact

MEDICAL INFORMATION

Insurance

REGISTRATION PAYMENT