Soccer Registration

Elmsdale Soccer Nights

Ages 5-7 - 6:30-8pm; Ages 5-13 - 6:30-8:30pm

Online Registration Form

* Indicates required field

1.) Child's Name *

First

Last

1.) Child's Age *

2.) Child's Name *

First

Last

2.) Child's Age *

3.) Child's Name *

First

Last

3.) Child's Age *

Child(ren)'s Address *

Line 1

Line 2

City

State

Zip Code

Country

Name of Parent / Guardian *

First

Last

Parent / Guardian's E-mail *

Phone Number *

Emergency Contact Information *

First

Last

Any medical or health issues for concern (including allergies) *

Phone Number *

I give permission to my child to attend Mount Zion Assembly's soccer program with the knowledge that my child will have to abide by the guidelines and rules of the program. I understand that my child will be encouraged to participate in all the activities such as playing soccer, doing soccer drills, listening to Bible stories and having snacks with other children.

I understand that Mount Zion Assembly volunteers love and care for my child, and have their safety in mind. However, in the event of an accident where my child may be injured (i.e. soccer incidents), I will not hold Mount Zion Assembly responsible, knowing that they have done whatever possible to prevent such an occurrence.

I understand that I am more than welcome to come and observe the soccer program at any time, and am free to speak to the Mount Zion Assembly volunteers concerning any concerns or questions I might have.

Parental / Guardian Consent *

I allow my child(ren) to participate in the soccer program

Agreement of Age *

I agree that I am 18yrs or older

Submit