TOPSoccer Registration

Please complete each section and click the "submit registration" button at the bottom of the form. Please note -- this is just a basic registration guide. The FULL TOPSoccer registration form must be completed as well. You can download this from the TOPSoccer web page - or pick it up at Spotsylvania Parks & Recreation.

1. PLAYER INFORMATION:

Please type TOPPSoccer in this line:

*First Name:

*Middle Initial:

*Last Name:

*Gender:

*Birth Date (mm/dd/yyyy): / /

*Street Address:

*City:

*State:

*Zip Code:

*Home Phone: --

2. CONTACT INFORMATION:

An e-mail address is required and very important for club announcements, game cancellations, etc.

*E-mail:

*E-mail (Verify by retyping):

I do not have an E-mail:

3. PARENT/GUARDIAN INFORMATION:

Parent/Guardian #1

*First Name:

*Last Name:

Home Phone: --

Work Phone: -- ext.

*Relationship:

Parent/Guardian #2

First Name:

Last Name:

Home Phone: --

Work Phone: -- ext.

Relationship:

4. EMERGENCY INFORMATION:

*Emergency Contact:

*Emergency Phone Number: --

5. POLICIES:

*Read the following information and check each box to indicate your agreement.

I, the parent or guardian of the player above, consents to his/her participation in any soccer-related activities. I agree to assume all risks incidental to such participation, including transportation to and from all activities. I hereby waive, release, absolve, indemnify, and agree to hold harmless FASA Hotspurs, its officials, sponsors, supervisors, and persons transporting my child.

I hereby give my permission for any and all medical attention necessary to be administered to my child in the event of accident, injury, sickness, etc., until such time as I may be contacted. This release is in effect for one year from registration. I also hereby assume the financial responsibility for the payment of such treatment.

Please review all information entered for accuracy and completeness, then click on the appropriate button below to continue the registration process.

Please contact me as soon as possible regarding this matter.

Please type TOPPSoccer in this line:
*First Name:
*Middle Initial:
*Last Name:
*Gender:
*Birth Date (mm/dd/yyyy):	/ /
*Street Address:
*City:
*State:
*Zip Code:
*Home Phone:	--

*E-mail:
*E-mail (Verify by retyping):
I do not have an E-mail:

*First Name:
*Last Name:
Home Phone:	--
Work Phone:	-- ext.
*Relationship:

First Name:
Last Name:
Home Phone:	--
Work Phone:	-- ext.
Relationship:

	I, the parent or guardian of the player above, consents to his/her participation in any soccer-related activities. I agree to assume all risks incidental to such participation, including transportation to and from all activities. I hereby waive, release, absolve, indemnify, and agree to hold harmless FASA Hotspurs, its officials, sponsors, supervisors, and persons transporting my child.
	I hereby give my permission for any and all medical attention necessary to be administered to my child in the event of accident, injury, sickness, etc., until such time as I may be contacted. This release is in effect for one year from registration. I also hereby assume the financial responsibility for the payment of such treatment.

Pete Cinalli, Director of Coaching FASA Hotspurs. All rights reserved. Revised: June 09, 2006 .

Pete Cinalli, Director of Coaching
FASA Hotspurs. All rights reserved.
Revised: June 09, 2006 .