Port City Soccer Club Summer 3 v 3 Soccer Registration

Now offering TWO sessions in TWO locations! Choose from Monday nights in June at Olsen Farm Fields or Monday mornings in Hampstead at the new Kiwanis Park!

Please check correct age group:

League

Location Preference:

Olsen Farm

Hampstead

Player Information:

First Name

Last Name

Street Address

City

State

Zip Code

Date of Birth

Gender

Male

Female

Please list any medical concerns (including contact lenses):

FAMILY INFORMATION

Please provide e-mail for game cancellations, schedule changes, updates:

Receive Mass Email?

If you would like to receive updates on field closings, game cancellations, special Port City Events, please check here. This is our main way of contacting you on short notice!

Mother's Name

Best number to reach Mom:

Father's Name

Best number to reach Dad:

Emergency Contact name (other than parent):

Emergency Contact phone number (other than parent):

ADDITIONAL INFORMATION

T-shirt Size

Did you play for Port City Soccer Spring 08?

Yes

No

If no, where did you play?

Would you like your child to play up an age group?

Yes

No

WE ARE A GREAT COMMUNITY VOLUNTEER ORGANIZATION - PLEASE HELP OUT WHENEVER & WHEREVER YOU CAN !

We Can Volunteer As:

I am interested in Summer 3 v 3 sponsorship opportunities:

yes

no

Sponsor name:

Sponsor contact:

Sponsor phone:

Would you like to make a tax-deductible donation to sponsor a child to play at Port City Soccer? If so, enter amount below:

Would you like to make a tax-deductible donation to PORT CITY SOCCER CLUB for field equipment and operational costs? If so, enter amount below:

Would you like to make a tax-deductible donation to OLSEN FIELDS for improvements and expansion? If so, enter amount below:

DISCLAIMER - Initials Required!

I, AS A PARENT OR GUARDIAN OF THE ABOVE NAMED PLAYER/PARTICIPANT, DO HEREBY GIVE MY APPROVAL TO MY CHILD’S PARTICIPATION IN ANY AND ALL ACTIVITIES OFFERED BY THE PORT CITY SOCCER CLUB ( PCSC ) . I ASSUME ALL RESPONSIBILITY FOR HAZARDS INCURRED IN THE CONDUCT OF ACTIVITIES, AND ALSO THE TRANSPORTATION TO AND FROM ACTIVITIES, AND I DO FURTHER RELEASE, ABSOLVE, INDEMNIFY, AND HOLD HARMLESS THE PCSC, US CLUB SOCCER, THE UNITED STATES SOCCER FEDERATION AND ALL OTHERS LISTED HEREAFTER: ORGANIZERS, EMPLOYEES, OFFICERS, BOARD MEMBERS, COACHES, REFEREES, SPONSORS, SUPERVISORS, AND LANDOWNERS PERMITTING USE OF THEIR LAND FOR SOCCER ACTIVITIES, ANY AND ALL OF THEM. I FURTHER AGREE TO ABIDE BY ALL THE RULES, REGULATIONS, AND DECISIONS OF THE PCSC AND AGREE TO ACCEPT ANY DISCIPLINARY ACTION TAKEN BY THE PCSC’S BOARDS, OFFICERS, OR REFEREES. I UNDERSTAND THAT MY CHILD’S PHOTOGRAPH MAY BE TAKEN DURING EVENTS AND GAMES BY PCSC PHOTOGRAPHERS AND MAY BE PUBLISHED THROUGH VARIOUS PCSC AFFILIATED MEDIAS INCLUDING, BUT NOT LIMITED TO, THE PCSC WEBSITE, CLUB NEWSLETTERS, AND PCSC BROCHURES. IN CASE OF ANY INJURY TO MY CHILD, I WAIVE ALL CLAIMS AGAINST THE PCSC, ORGANIZERS, SANCTIONING BODIES, COACHES, SPONSORS, S.A.W., LANDOWNERS OR ANY OF THE SUPERVISORS APPOINTED BY THE PCSC. BY INITIALING BELOW, I AGREE WITH THE ABOVE DISCLAIMER.

FEE SECTION AND LOCATION OPTIONS:

Includes a FREE t-shirt!

Summer 3 v 3 Soccer at Olsen Farm (35.00 + 2.00 credit card transaction fee)

Summer 3 v 3 Soccer in Hampstead (25.00 + 2.00 credit card transaction fee)

** Olsen Farm location for 4 Monday night sessions in June!

Dates: 6/9, 6/16, 6/23 and 6/30 starting at 6:00 pm

**Hampstead location for 3 Monday morning sessions in June!

Dates: 6/16, 6/23 and 6/30 from 9 - 11:00 am.

Unfortunately, space cannot be held for unpaid / incomplete registrants. I understand that by registering online and not making payment at this time that my child's registration will only be held for 5 days.

Yes

Please try to arrive on 6/9 at 5:45 to check in and get your t-shirt before starting the program. THANK YOU!

Indicates Response Required

First Day Check-In	Assistant Coach
Concessions	Sponsorship/Fundraising
Landscaping/Maintenance	Other
Not at this time