Soccer Registration Form 2018
 
Soccer Registration Form 2018
Indoor Soccer League for Boys and Girls Age 4-7
Registration Cost is $72, including $3 processing fee. NO REFUNDS AFTER ORIENTATION.
Player’s Last Name  * 
Player’s First Name and Middle Initial  * 
Gender  * 
Date of Birth  * 
Player’s Age  * 
Street Address  * 
City and Zip Code  * 
Home Phone
Cell Phone
Father/Guardian Information Below:
Father/Guardian Name
Father/Guardian Relationship to Player
Father/Guardian Phone #’s (list all that apply)
Father/Guardian Employer/Phone
Parents are encouraged to take an active part in the league through coaching and refereeing. Your participation is vital to the success of the league. Please select all that apply:
I can help as Coach/Referee  * 
I can help as Team Parent  * 
Mother/Guardian Information Below:
Mother/Guardian Name
Mother/Guardian Relationship to Player
Mother/Guardian Phone #’s (list all that apply)
Mother/Guardian Employer/Phone #
Parents are encouraged to take an active part in the league through coaching and refereeing. Your participation is vital to the success of the league. Please select all that apply:
I can help as Coach/Referee  * 
I can help as Team Parent  * 
Emergency Contact Name  * 
EMERGENCY CONTACT INFORMATION
Emergency Contact Phone Number  * 
Emergency Contact Name (Secondary)
Emergency Contact Phone Number (Secondary)
Does this child have any disabilities, handicaps, present injuries or limitations, allergies, hemophilia, heart condition, or history of respiratory illness?  * 
If Yes, please state conditions:
Does this child have any other significant medical condition (not mentioned in previous question)?  * 
If Yes, please state condition(s):
If you wish to have your family doctor contacted in case of emergency, please provide name and phone number.
EMERGENCY AUTHORIZATION - I, the authorized parent or legal guardian of this minor, agree to all of the following statements:  * 
I authorize the coaches, assistants, or parents of team members acting in the capacity of activity supervisors/vehicle drivers, as my Agents, to consent to the following:
To Medical, surgical or dental examination and/or treatment. In case of emergency, I hereby authorize treatment, and/or care at any hospital.
If there is an emergency and I cannot be reached, I authorize that my emergency contact (provided in this form) be contacted.
I agree to all of the following statements of waiver of Liability and Disclaimer:  * 
I agree to waive all liability from Freedom Church while playing and/or participating in the Kids Indoor Soccer League.
I accept all responsibility for any injuries that may occur while on the premises to my child or children, group or members.
I will not hold Freedom Church liable for any lost or stolen items while on the premises.
Player Info: Players are required to have NON MARKING GYM SHOES AND SHIN GUARDS COVERED WITH SOCKS. No skorts are allowed. Regular shorts are required.
PRACTICES will be held once weekly on Tuesdays or Thursdays, beginning August 28th at the Community Life Gym
Comments:
If you have questions, call 406-652-3918 or e-mail sports@billingsfreedomchurch.com
Your Email Address  * 
Total $
 
 
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