Cheektowaga Soccer Club
P.O. Box 1865 - Cheektowaga, New York 14225

Please complete all of the fields on the application, print the application, and mail it with your registration fee. Leave the fields blank to fill out the application by hand.
Last Name:
First Name:  

MI:
Email:

Address:

Town/Zip:

     

Phone:

Birth Date: / /

Age in Sept.:

School:

Grade:
Gender:

     M______   F______

Registering for (Check all that apply)

Fall House League
Winter House League
UNIFORM SIZE: 

AXL   AL   AM    AS             YXL   YL   YM    YS

Do you have interest in playing travel soccer?                              Y ____  N____
Father's name: _______________________________      Phone: _________________________              Mother's Name: ______________________________      Phone: _________________________          Emergency Contact: ___________________________     Phone: _________________________             Relationship to Applicant: _______________________                                                             

Medical Considerations:__________________________________________________                             Insurance Coverage:_____________________________________      

Would you like to coach a house league team?  Y_____   N_____                                                                          Has this child ever played soccer before?   Y ____     N____ , If so how many years? ______                             Has this child ever registered with CSC before?    Y_____ N_____                                                                    What teams/leagues have they been involved with? _______________________________                                                    

***By signing this waiver, I give my permission to the Cheektowaga Soccer Club to use my child's photograph in publications of the association, which include info. & public relations materials, such as newsletters & our website (www.mcsoccer.net) This release is in effect until such time I request in writing that I want to discontinue the use of my childs photos.*** I understand that participation in youth soccer presents a risk of injury, and I agree to hold harmless and indemnify the Cheektowaga Soccer Club,it's board, officers, coaches, and members, for and against any and all claims of any nature from my child's participation in the soccer program. I certify that my child has been declared by a physician to be physically able to participate in the soccer program without any restrictions.

Parent or Guardian's Signature: __________________________________         

Print Parent or Guardian's Name: ________________________________            Date: ______________________