Please fill in player information section as completly as possible
Given Name:
Middle Initial:
Surname:
Birth Date: Year 198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 Month 123456789101112 Day 12345678910111213141516171819202122232425262728293031
Sex:MaleFemale
MCP:
Address:
City:
Postal Code:
Telephone: (H)
Telephone: (C)
Email:
Name:
Phone (W):
In case of a emergency contact:
Phone:
Volunteers:Do you wish to assist the CBS Soccer Association in administering its programs?
Yes No
If YES, please indicate in what capacity:
Coach Assistant Coach Helper Canteen Other
Family Doctor:
Does your child carry or require an Epipen or other life saving service? Yes No
Does your child suffer from any Allergies or other medical condition? Yes No
If YES, describe:
WAIVER: I/we give permission for our son/daughter to participate as a registered player with the CBS Soccer Association. I/we understand that the association and its representatives will not be held liable for any loss, accidents or injury during your son/daughters participation in soccer activities or traveling to or from practice or games.
I AGREE: Date:
Your child's photo may appear on our website or other mediums for the purpose of club exposure and/or player recognition
Do you object? Yes No