Deer Park Soccer - Online Registration

Thank you for using the Deer Park Soccer League Online Registration Form to register your son or daughter for Spring 2010 soccer!

Instructions

To register your son or daughter for soccer, follow these steps:

Complete the form below and press the Submit Registration Button at bottom of the page. Fields in bold are required!

Once you press the Submit button you will be provided with a confirmation message for your registration that will provide a summary of your registration.

Player Information

Last Name
(Childs) First Name		Parents - Please enter the Childs First Name - NOT Your first name!
Street Address
City/Township
State
Zip
Phone Number	()--
Alternate Phone Number	()--
Gender:	Male Female
(Childs) Birthdate:	Month Day Year	Player birthdate should be on or after: 1994-08-01 on or before: 2004-07-31
Current Grade in School:		Grade your son or daughter is School as of today.
Playing Experience:	(Years Played)	Number of years your son or daughter has played soccer.
Plays Up?	Yes No	My son or daughter usually plays up an Age Division.
E-Mail Address		A confirmation message will be sent to this e-mail address.
Alt. E-Mail Address		A confirmation message will be sent to your e-mail address.
Parents
Comments		Enter additional information or comments about the registration form in this area.

Emergency Contact Information

Emergency Contact Name
Emergency Contact Phone
Family Physician
Family Physician Phone
Comments		List any known medical conditions or problems the coach should be aware of

Volunteer Information

	Note: If you Volunteer as a Coach below you will be provided with a separate link at the end of the registration process to a Coach Registration Form...
Volunteer As Coach	Coach Asst. Coach Not Available
Volunteer as Referee?	Yes No
Referee Name		Name of the person who is interested in volunteering as a Referee
General Volunteer?	Yes No
Other Volunteer Interests		Please list any other interests or ways you might be able to volunteer.

Uniform Information

Jersey Size
Short Size
Sock Size

Registration Fees

Fee Item

Description

Fee

Spring 2010 Registration Fee

$55.00

*** TOTAL ***

Payment Information

Payment Method

Check By Mail Credit Card

Name On Card		Enter name exactly as it appears on your Credit or Debit Card
Credit Card Number		Enter Credit Card Number with NO spaces or dashes. All Credit Card information transmitted over a secure 256-bit SSL connection.
Card Expiration Date	/	Enter credit card expiration date (mm/yyyy).
Cardholder Street Address		Enter your billing Street Address for this Card
Cardholder Zip Code		Enter your billing Zip Code for this Card
Credit Card CCV Code		Enter the 3 digit Card Card Validation Value located on the back of your card.

Health and Legal Disclaimers

Checking the box(s) below means you have read and accepted the agreement(s)

I, (Parent/Guardian), certify that my child is in good physical condition, is fit to participate in the Deer Park Soccer League and suffers from no physical impairment that might be aggravated by said participation. I certify that my child is covered by medical insurance, and that I will not hold Deer Park Soccer or its representatives responsible for any injuries or harm to my child which occurs during participation in the program.

We, (Player & Parents/Guardians) further agree to abide by ALL Deer Park Soccer League rules and to conduct ourselves in a sportsmanlike manner during all Deer Park Soccer League related activities. We further agree to abide by all directions and decisions of the referees, coaches, and officials of the Deer Park Soccer League. We realize that violations of the above are consequential and could result in our suspension for one (1) or more games.

WE HEREBY AGREE THAT THE SOCCER ASSOCIATION FOR YOUTH (SAY) ITS MEMBERS, COACHES OR OFFICERS SHALL NOT BE LIABLE FOR ANY INJURY OR LOSS WHICH MY CHILD MAY SUSTAIN WHILE PARTICIPATING IN ACTIVITIES OF ANY KIND WHETHER SPONSORED BY OR UNDER THE SUPERVISION OF SAY AND WE AGREE TO INDEMNIFY AND TO HOLD HARMLESS SAY, ITS MEMBERS, COACHES, OFFICERS OR DESIGNATES OF ANY KIND FROM ANY CLAIM WHATSOEVER.

Please press the Submit Button only once to avoid a duplicate registration and duplicate charges to your credit card. It takes just a couple of seconds to register. The next screen will provide payment information.