Soccer Registration Form

Verrado Heritage Soccer Registration

Big Goal Soccer League 3 to 12 Years Old
PLEASE READ BEFORE YOU START:

You will need to fill one registration per child. Once you have completed the regsitration and payment you will need to start a new registration form for the next child.
CHILD INFORMATION:
Child Name *

First Name Last Name
Birth Date *

Month Day Year
Male/Female *
Special Requests
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
E-mail *
I would like to Coach *

Yes No
Jersey
Youth Size
Adult Size
REGISTRATION PAYMENT
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 Big Goal Verrado Soccer League (BGVSL) including refund policy, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the BGVSL, accepting the registrant for its soccer programs and activities (the "Programs"). I hereby release, discharge and/or otherwise indemnify the BGSVL, 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.

Refund Policy:
once teams have been assembled and/or uniforms purchased for the players and teams, the fee is Non-Refundable. Any registrations/payments made will carry over to next league.
Make Payment *
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Soccer Registration - One Child $ 75.00

Total $ 0.00

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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Verrado Heritage Soccer Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

Jersey

REGISTRATION PAYMENT