Soccer Club Spring 2022
Registration $30 ($25 if you already have a jersey)
Submit form.  You will be contacted by the coaches and make payment to the coaches.

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Player First Name *
Player Last Name *
Age *
Date of Birth *
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Grade *
Address *
City *
Preferred Contact Phone Number *
Alternate phone number *
Email Address *
Parent's Names *
Emergency Contact Name *
Emergency Contact Phone Number *
Any medical Information?
Has this student ever played soccer before? *
If you have a jersey for this season, what is your number?
If you need a NEW jersey for this season, please indicate your jersey number preferences? - 1st CHOICE
If you need a NEW jersey for this season, please indicate your jersey number preferences? - 2nd CHOICE
If you need a NEW jersey for this season, please indicate your jersey number preferences? - 3rd CHOICE
Select shirt size:
Clear selection
Medical Treatment Authorization and Liability Waiver: I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry provide the participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment.  I understand the treatment for injury will be based on information provided herein.  I hereby authorize emergency transportation of the patient to a medical treatment facility should an individual listed above consider it to be warranted.  I recognize the possibility of injury associated with soccer, and hereby release, discharge, and otherwise indemnify the Mountainburg Soccer Club, their sponsors, affiliated organizations, and employees against any claim by or on behalf of the soccer player named above as a result of that player's participation in the Mountainburg Soccer Club. *
Form of Payment *
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