PROGRAM #10 WINTER LEAGUE – Monmouth Ocean Middlesex County Soccer League (MOMCSL)

7v7 Indoor League Individual player registration:

Individual players can register for a 10 weeks league game, we’ll find you a team to play. Games are on Saturdays or Sundays start January 4^th and January 5^th & end on March 14^th and 15^th,

Individual Registration is $125.00

Email bksoccerpd@aol.com or call Ben Konate 732-670-5891

INDIVIDUAL REGISTRATION FORM

Player Name (required)

Boy Girl (required)

Age (required)

Level (required)

Program (required)

Address (required)

City (required)

State (required)

Zip (required)

Phone (required)

Emergency Contact

Name (required)

Cell (required)

Phone (required)

Waiver Information

I certify that my child(ren) is in good health and is/are able to participate in physical activity including all sports. I agree to hold SPD, its agents and employees harmless for any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child(ren) to receive emergency medical treatment.

Parent Signature (required)

Credit Policy

A voucher for the full program fee will be issued for any cancellation prior to the program. No cash refunds.
I, the undersigned hereby certify I am legal guardian of above camper.

Legal Guardian Name: (required)

Legal Guardian Signature: (required)

Date (required)