AC Soccer Club Registration

U4 - U19 Boys & Girls

Last Name: First Name:
Tel#Home:Tel#Work:  Girls  Boys
Address:       Zip:
Birth date: xx/xx/xx  Email:
Player's Last 4 digits of Social Security Number: xxxx
Additional comments / Potential schedule conflicts:

You need to pick up your Uniform two-weeks prior to start of the session from:

 Soccer Zone
(402) 331-9550
4304 S 84th St
Omaha, NE 68127

Parental Support

HeadCoach

AssistantCoach TeamParent Sponsor Field Help

Space is limited, therefore selection is based on a first come, first served basis.
Please mail your registration and fee to AC Soccer Club - Registrar.

AC Soccer Club - Registrar
3931 N. 94 St
Omaha, NE 68134

The undersigned parent/guardian of the above named player agrees to the following:

1.      Approve of his/her participation in all AC Soccer Club activities.

2.      Assume all risk and hazard incidental to such participation including, but not limited to, transportation too and from club activities, practices, clinics and games.

3.      Shall hold harmless The AC Soccer Club, its organizers, sponsors, coaches, supervisors, participants and persons transporting such child to and from any club activities from claim arising out of the injury to such child.

4.      Acknowledge that The AC Soccer Club does not provide any type of insurance for any player and that the parent/guardian carries health insurance that will cover all accident or injury claims that are associated with the game of soccer or related activities at The AC Soccer Club.

Parent or Guardian Signature:

NEW PLAYERS must submit a photo and a photo copy of their birth certificate at the time of registration.

Please contact me as soon as possible regarding this matter.

VERY IMPORTANT*** Please Print this form BEFORE you Submit

 

Revised: 15 Jul 2008 17:56:49 -0700 .