Player Information Form - Smufc
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1
2South Miami United F.C.
Rec Soccer Season 2016 - 2017
Player Information Form
C: ___________________________
FOR OFFICE USE ONLY
_____
Name: _____________________________________________ Gender: M or F Age:
Last/First
Division: (circle according to the age group chart below)
-U4 Coed
-U6 Coed
-U8 Coed
-U10 Coed
-U12 Coed
U4: 2013 / Max 8 players (Co-ed) / 4 vs. 4 no goalie
U6: 2011-2012 / Max 8 players (Co-ed) / 4 vs. 4 no goalie
U8: 2009-2010 / Max 8 players (Co-ed) / 4 vs. 4 no goalie
U10: 2007-2008 / Max 12 players (Co-ed) / 7 vs. 7
U12: 2005-2006 / Max 12 players (Co-ed) / 7 vs. 7
Birth Date: __ __/ ____/______
Special Request: ____________________________________
(We will attempt to accommodate special requests)
Name of Parent/Guardian: ________________________________________________________
Address: ___________________________________ City/State: ____________ Zip: __________
Phone: (cell) _____________________________ (home) _____________________________
E-mail address: _______________________________________________________________
Medical Conditions/Allergies: ___________________________________________________
Emergency Contact: ___________________________________________________________
Name/Phone
FOR OFFICE USE ONLY:
Registration Check List
Payment Information
o Player Registration Form – signed
o Player Information Form – signed
DATE
o Copy of Birth Certificate or Passport
PYMT TYPE
o Concussion Notification – signed
o Medical Release – signed
AMT DUE
o Registration Fee $235 – checks payable to SMUFC
o OPTIONAL: Grey Training T-Shirt for an additional $10
REC’D BY
Jersey Size: (circle) Youth XS S M L XL
Please see reverse for Liability Waiver
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Parent category: Miscellaneous