EmailMe Form - Hamersville 2017 Fall Soccer Signups

Athlete Name: *

First Last

School Attending *

Child's Grade 2017/2018 School Year: *

Child's Age *

Child's Birthdate: *

MM / DD / YYYY

Child's Gender: *

Female

Male

Parent Name *

First Last

Please only enter one parent name.

Phone *

### - ### - ####

Please enter the phone number for the parent entered in the previous field.

Address *

Street Address City State / Province / Region Postal / Zip Code

Email *

Soccer Uniform Needed: *

Yes

No

If you already have a uniform please select NO.

Soccer Uniform Size: *

If NO was selected in the previous field enter N/A.

Comments:

Birth Certificate: If FIRST YEAR player, please upload photo of Birth Certificate. You may also text a picture of the Birth Certificate to Jessica Hornsby (513)500-7428.

Click "Browse" button to select picture.

If you have selected to upload a picture of the birth certificate, your submission will take longer to process. PLEASE ONLY CLICK THE SUBMIT BUTTON ONCE.

Signature *

Clear

Standard Player Team Agreement found on CCSA Registration Form.
We hereby agree that the Clermont Central Soccer Association, its members, coaches or officers shall not be liable for any injury or loss which my child may sustain while participating in activities of any kind whether sponsored by or under the supervision of CCSA and we agree to indemnify and to hold harmless CCSA, its members, coaches officers or designates of any kind from any claim whatsoever.

PARENT CONDUCT AGREEMENT: Youth sports programs play such an important role in promoting the physical, social and emotional development of children. It is therefore essential for parents to encourage youth athletes to embrace the values of good sportsmanship. Moreover, adults involved in youth sports events should be models of good sportsmanship and should lead by example by demonstrating fairness, respect and self control.

PLEASE ONLY CLICK THE SUBMIT BUTTON ONCE!!!! If you are attaching a birth certificate your submission will take a little longer to process.

Please check your email to verify your submission before resubmitting your signup. You will receive a confirmation email when signup is received. Also check spam or junk folder for the confirmation email.