SPRING 2016 RECREATIONAL SOCCER

303 –669-0402 FEES: $95.00

If you want to be placed on the team you played for in the SPRINGplease register early after FEBUARY 1stits first come BASIS. FIRST GAMES WILL BE March 19th

Please complete all of the following information. To avoid delay on placing player on a team please make sure have done the following: all information is completed, full payment is included and if player is NEW we will need a copy of a Birth Certificate. One form must be completed for each player. Registration forms are completed on a first come first serve bases and teams are formed based on availability of coaches and players. Returning players from previous season are only guaranteed placement on his/her same team if there is availability on the team and registration is submitted by early registration cut off. It is imperative that you print legibly.

Player’s First Name______Players Last Name______Best Contact Number ______

Players Address______Players City and Zip Code______

Players Date of Birth______Players Age______Players Age Group______Players Sex: M F

Preferred ESA Team______Jersey #______Will a New Jersey be needed: Y N what size: ______

Guardian/Mother Full Name______Cell # ______Text Prov______

Guardian/Father Full Name______Cell # ______Text Prov______

An email address is required for schedule changes: ______

Emergency Contact Full Name______Contact #______

Permission to Play, Release of Liability, and Consent or Medical Treatment:

This is to certify that the child named herein ‘Player’ has permission to play soccer with Englewood Soccer Association. It is understood that participation in this sports activity involves risks that could result in injury to the ‘Player’. The undersigned expressly assumes any such risks, and waives and releases Englewood Soccer Association, its Board of Directors, Officers, Coaches, Referees, Volunteers, Employees, and Agents, from any and all claims or causes of action or liability he/she knows as the ‘Player’ may have as a result of any such injury, whether as a result of negligence, breach of warrant, or otherwise. I hereby give my consent of an all emergency medical care reasonably required or prescribed by a licensed physician or dentist for the ‘Player” identified above. Care may be administered under whatever conditions necessary to preserve life, limb or well being of the ‘Player’. Please list any medical problems or limitations of the ‘Player’ that the coach should be aware of. ______

Signature of Parent/Guardian______Date______

Englewood Soccer Association is an ALL volunteer organization; its continued success is based on the commitment of volunteerism. Please indicate which positions you are able to help with:

CoachAssistant CoachTeam RepresentativeRefereeLinesman

Qualifying Age Groups Based on D.O.B

U6 08/01/09-7/31/11U10 08/01/05-7/31/06U14 08/01/01-7/31/02

U708/01/08-7/31/09U1108/01/04-7/31/05U15 –U17 08/01/00-7/31/99

U808/01/07-7/31/08U1208/01/03-7/31/04

U908/01/06-7/31/07U1308/01/02-7/31/03

Family Discount: The first two children from same household pay full registration, Child 3 and 4 from same household will receive a $35.00 discount per child if there are more than 4 please contact us VIA email and we can discuss payment.

Refund Policy: Refunds must be requested in writing. A $12.00 administration fee will be deducted from any refund. After the first schedule games no refunds will be given, unless documented by a physician due to illness or injury. A refund will not be granted if a child can be placed on a team and chooses not to play. REFUNDS WILL NOT BE ISSUED TILL END OF SEASON!!!!!ESA * 4725 S. Kalamath Englewood, CO 80110*englewoodsoccer.org *