Soccer Registration Form

Nature Coast Soccer Club
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.
Please choose which child this is.
PLAYERS 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.U5 to U18,

We are aso starting the Little Lightning league for our 3 and 4 year olds, The cost to register them is $40,

The is also a $25 volunteer fee. If you volunteer 4 hours durning the seson and the hours are logged and reported to the registrar then you will be reimbursed the $25 at the end of te season.

You will need to provide a birth certificate and a current photo 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

Soccer Registration Fees: Choose only one

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

This fee includes the registration of $85 and a 1 time family volunteer fee of $25. There is a $5 discount for each additional sibling, up to 3 siblings

Second Child Registration $80 plus service fee $ 80.00

This fee includes the second player registrations.

Third Child Registration $75 plus service fee. $ 75.00

This fee includes the third player registrations.

Fourth Child Registration $70 plus service fee $ 70.00

This fee includes the fourth player registration.

Little Lightning 3 / 4 year old. $ 40.00

This is for players with a Birth year of 2018 or 2019.

TOPS Free

This soccer is for players with disabilities. There is no fee for this registration.

Credit Card Service Fee $ 5.00

This is a service fee for using a credit card. It is charged per transaction. Please check the box to continue on.

Total $ 0.00

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

Should be Empty:

Nature Coast Soccer Club

PLAYERS INFORMATION:

PARENT/GUARDIAN INFORMATION:

UNIFORM INFORMATION

Emergency Contact

MEDICAL INFORMATION

Insurance

REGISTRATION PAYMENT