Portland Community Football Club – Fall 2015

Player(s) Information – Please PRINT

First Name / Last Name / Birth Date / School

Parent/Guardian Information – Please PRINT

First Name / Last Name / Cell Number / Email
Street Address / City/State / Zip Code / Home Number

Please check the best methods of contact:Emergency Contact #1:______Phone:______

Text  Email  Phone Call

Emergency Contact #2:______Phone:______

Level of Play Options: Please Check ONE (For multiple players please also mark ‘D’, ‘R’, or ‘C’ next to each name)

Development – Open to 5 – 8 year olds. This level is for players just learning soccer. Players will learn the basics through fun skill-based games. A commitment to attend one practice and one game per week is strongly suggested.

Recreational – Open to 9 – 15 year olds. This level is for players that are just learning or are not interested in competitive level.

A commitment to attend two practices and one game per week is strongly suggested.

Competitive – Open to 10 – 15 year olds. This level is for players that want to have a high intensity level of training and play.

A commitment to attend two practices per week and all games is REQUIRED. Additional individual work outside of practices will also be expected. Coaches and Club Director will consult with players and parents to discuss more details.

Sliding Scale Fees: Please pay any amount in the scale – FEES DUE BY 4th Week of the season

  • Development Level: $5 - $50 per player Recreational Level: $5 - $75 per player
  • Competitive Level: $10 - $100 per player Competitive Level: $100 - $500 per player (Full Year) NOTE: Year-long commitment required for this level

Scholarship Information:

PCFC is committed to providing every player with a high quality experience regardless of income level.

Receive free and/or reduced lunch?  YESNO (this answer does not affect your scholarship)

What level of scholarship are you requesting? Full Partial – I can make monthly payments of $____ per month

PCFC provides soccer cleats at no extra charge for those who need them-Please consider donating cleats that are too small!Please fill in the size number: (one pair per player)Size: _____ Size: ______Size:______

I understand the risks and hazards associated with my child’s participation in the above activity. I certify that my child is in good health and give my permission for their participation. I authorize all emergency and medical treatment, which may be needed in the event of any injury. I also understand that primary insurance coverage is my own responsibility. In consideration of such admission, I do hereby agree to release, discharge, and hold harmless PCFC and each of its directors, officers, agents, employees and volunteers of and from all causes, liabilities, damages, claims, or demands whatsoever on account of any injury or accident involving the said minor arising in the course of competition and/or activities held in connection with the season. PCFC has my permission to photograph my child to use in marketing and promotional materials. Initial required:______

Parent/Guardian Signature: ______Date:______