SOUTH BERGEN UNITED SOCCER LEAGUE

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SBSL Player Registration Form (Test)

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

School:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

TOWN/PROGRAM INFORMATION

Town:

Town/Program Representative:

Insurance Carrier:

Policy #:

TEAM INFORMATION

* Division:

U10 Boys

U10 Girls

U12 Boys

U12 Girls

U14 Boys

U14 Girls

U17 Co-ed

Age (Prior to August 1st):

* Team Name:

WAIVER INFORMATION

I, the parent/guardian of the above named player, a minor, agree that I and the player will abide by the rules and regulations of the SBSL, USSF, USYS, and its affiliated organizations and sponsors. In consideration of the player’s participation in the soccer programs intending to be legally bound, hereby release and indemnify the SBSL, USSF, USYS, the owners and operators of the facilities used for the Programs and their respective directors, officers, employees, agents and representatives from and against all claims, liabilities, damages or causes of action arising out of or in connection with the player’s participation in the Programs including, without limitation, player’s transportation to/from any Program, which transportation is hereby authorized. I further grant the SBSL, USSF, USYS, and their sponsors the right to use the player’s name, picture and/or likeness in printed, broadcast and other material concerning the Programs provided such use is related to the player’s status as a participant of in the Programs.

I/we agree with the above *

* indicates required fields

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SBSL Player Registration Form (Test)