P.O. Box 128, Ashland City, TN 37015
Phone: 882-0405
(You may print out and mail this form)
or
Call for drop off locations
If you want your child to be on a certain team
(or) to return to the same team;
Registration has to be in PRIOR to
Draft Day NO EXCEPTION!!
any registrations post marked or received on or
after Draft day will be entered in draft sequence
Player's
Last Name:
First Name:
M.I.:
Street Address:
City:
State:
Zip Code:
Phone:
Cell Phone:
Sex: Birth Date:
E-Mail Address:
Uniform size: Jersey size: Shorts size:
( Games will be at River Bluff Park)
Father's Last Name:
First Name:
MI:
Mother's Last Name:
First Name:
MI:
Last Year's Coach:
List
medical problems or limitations of the player:
Did you play last Spring
or last Fall:
School:
Grade in School:
I, the parent or guardian of the registrant, a minor, agree that the registrant and I
will abide by all the rules of the Cheatham County Soccer Association (CCSA)
and its affiliated organizations and sponsors.
Recognizing the possibility of physical injury associated with soccer and in
consideration for the "League" accepting the registrant for its soccer programs and
activities (the "Programs"), I hereby release, discharge and/or otherwise indemnify the
CCSA, its affiliated organizations and sponsors,
their employees and associated personnel and
volunteers including the owners of the fields and facilities utilized for the
Programs, against any claim by or on behalf of the registrant as a result
of the registrant's participation in the Programs
and/or being transported to or from CCSA sponsored activities which
transportation I hereby authorize.
Name__________________________________
Signature________________________________
Date ______________
The Cheatham County
Soccer Association is an all volunteer organization. Parents have an
obligation to participate in the activities of the club. Please
indicate the areas where you can volunteer. Training is available.
Coach:
Coached Last Season:
Asst. Coach:
Asst. Coached Last Season:
Referee:
Board Member: Team
Parent:
Club Workday (approx. 2-3 hrs.):
Concession Stand (approx 2-3 hrs):
OFFICIAL USE ONLY Registration Fees:
Player fee:.............$ _________
Late/Other fee:.....$ _________
Subtotal.................$ _________
TOTAL.................$ _________
Cash ____ Check No.________
Received by_____ Date______
