Monroeville Soccer Club

1161 Colgate Drive

Monroeville, PA 15146
monroevillesoccer.org
Player Information:
Players Name: _______________________________ Sex: _____ Date of Birth: ___________________
Address: _______________________________ City: ____________________________ Zip: _________
2014-15 School Grade: ________________________________________ Uniform Size: ______________
Last Years Coach:_________________________________ Years Played: _________________________
Parent Contact(s): _______________________________________________________________________
Phone #(s): _______________________________

2nd: _______________________________________

Email Address: _________________________________________________________________________

Email Address: _________________________________________________________________________
Emergency Contact: ________________________________ Phone #: ____________________________
List any allergies, medications or health problems the coach should know about: _____________________
Volunteer Information:
Coach* _______ Asst. Coach* _______ Concession Stand __________ Other __________________
*U6, U8, U10 and travel coaches are required to complete a PA West sponsored age appropriate, or higher, coaching
license by September 30, 2014 at no cost. Failure to complete the class may result in loss of your coaching assignment.
All MSC coaches and volunteers are required to have clearances approved by the Risk Management Coordinator.
We the undersigned parent/guardian of a MSC player, do hereby agree that he/she may participate fully in the practice and game
of soccer. We do further agree for, and on behalf of, our child and for ourselves, individually and severally, that we will assume
all risks attendant to travel and playing soccer and that we will not hold Monroeville Soccer Club, their coaching staff, referees or
PA West liable for any claims involved in soccer.
I am aware of Monroeville Soccer Club's Code of Conduct that sets rules for parents, players, referees and coaches. My signature
below acknowledges that a copy exists on the website www.monroevillesoccer.org and a copy is available along with the
registration form.
I hereby release Monroeville Soccer Club, their coaching staff, referees or PA West for any liability for its acts or omissions.

Parent/Guardian Signature: ________________________________________ Date: _________________

______________________________________________________________________________________

Registrar Use Only:

Date paid:
This form amount:
Check amount:
Check # or cash:
Initials:
In-house Fees

__________
__________
__________
__________
__________

Additional Player: _________________

Additional Player: _________________
Age Group: ______________________
Travel Fees

In-house & Travel Fees (play both)

U6-U13 Fall & Spring - $80.00

U10-U19 Fall & Spring - $110.00 U10-U13 Fall & Spring -$145.00
Fall OR Spring - $70.00
Fall OR Spring - $95.00
Fall OR Spring - $130.00
Additional Child - $10.00 discount for all leagues
$30.00 fee for all returned checks.
$25.00 late fee for ALL currently registered in-house players, after 7/15/14
$50.00 late fee for ALL travel players after 6/15/14