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SRSC Registration 2017-2018

* Player First Name:

Player Middle Name/Initial:

* Player Last Name:

* Date of Birth:

* Gender:

Female

Male

* Street Address (No P.O. Box):

* City:

* State:

* Zip Code:

* School Player Attends:

* Current Grade in School:

* Primary Contact (which should be person completing form):

Father

Mother

Guardian

* Primary Contact Name:

* Primary Contact Address (if same as above, write SAME):

* Email Address:

Email Address (Alternate):

* Telephone:

Telephone (Alternate):

SRSC depends entirely upon parents who volunteer their time and effort to support their children and youth soccer in general. Without parents like you, this organization could not survive. Please give serious consideration to helping your child's team and our Club in some tangible way.

Qualified parents who volunteer as a coach will receive a refund at the end of the season of one child's registration fee. This refund is contingent upon completing the entire season as coach. This fee will not be split by the Club between two or more parents who coach one team. Parents who coach two teams with a child on each team will receive two refunds.

* I can volunteer as...:

Head Coach (Each Head Coach who serves for entire season receives refund of his/her child's registration fee on the team coached.)

Assistant Coach

Team Parent

Board Member

Other (List in Comment Section below)

Sorry I cannot help

Secondary Contact:

Father

Mother

Guardian

Relative

Friend

Parent/Guardian/Secondary Contact Name:

Parent/Guardian/Secondary Contact Address (if different from Player address):

Email Address:

Telephone:

* Player Uniform Shirt Size:

* Player Uniform Shorts Size:

* Player Uniform Sock Size:

* Player's Prior Soccer Experience (Years):

* Play with SRSC last year?:

Comments/Suggestions:

Please list here any medical problems or other limitations may have which your child's ability to play soccer:

By checking this box and submitting this form, I give my consent to SRSC, its directors and coaches to obtain any medical treatment deemed necessary by them in the event of an emergency and in my absence. *

The registration fee is $110.00 for Pascagoula residents and $165.00 for non-residents. That fee includes uniform, referee fees, district tournament fee (if your team qualifies), insurance and all the club's expenses. It does not include shoes, shin guards or balls.

The City of Pascagoula requires SRSC charge this higher rate for non-residents. The difference between the higher rate and the rate for residents goes to Pascagoula's Recreation Department. The City also mandates we obtain from each family proof of residency within the City. Proof of residency can be a utility bill, real property tax bill, land deed or other form of acceptable document in the name of a parent or legal guardian of the registering player. This proof can be sent to the SRSC Registrar, Mandy Rickher at mandysaysimdone@gmail.com.

If you have more than one player in a single family, you will receive a discount of $10.00 off the registration fee for each sibling you register after your first child. So if you register a 12 year old son, and later an 8 year old daughter (and both are residents), then your total fee will be $210.00 ($110 + 100). However, you MUST write the FULL NAME of the first child you registered in the "Comment/Suggestions" section above. Failure to do so, means your registration is not complete.

NO CASH WILL BE ACCEPTED AS PAYMENT FOR REGISTRATION. If for any reason you do not pay on line, then you must (a) fill out and print the online registration form, and (b) bring it to a live, in-person registration session. The dates and times for such registration will be listed on this web site.

YOUR REGISTRATION IS NOT COMPLETE UNTIL (A) PAYMENT IN FULL AND (B) ALL REQUIRED DOCUMENTATION (e.g. birth certificate for new players, proof of residency for Pascagoula residents) ARE ALL RECEIVED BY SRSC.

By checking this box and submitting this form, I acknowledge that by registering with SRSC my son/daugter and I enter into a binding committment to complete his/her requrements as a registered player with SRSC. *

If I am a resident of Pascagoula, I acknowledge that my registration is not complete until I have furnished proof of residency to SRSC. *

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

Singing River Soccer Club

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