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Soccer Registration Form
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Indicates required field
Players Full Name
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First
Last
Sex
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Male
Female
Player's Date of Birth (format Month / Day / Year Example 01/01/2020)
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Booneville or Magazine Team
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Booneville
Magazine
Please select a Jersey size
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Youth extra small
Youth Small
Youth Medium
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Adult 2X
Adult 3X
Adult 4X
Adult 5X
Parent / Guardian Name
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First
Last
[object Object]
Phone Number
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Secondary Parent / Guardian Name
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First
Last
[object Object]
Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
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Family shirts are available for an additional $12.00. An additional fee for sizes 2XL and Larger. Family shirts will be the same team color as your players. If you would like to purchase a family shirt please select yes and we will send you an email with a link to purchase.
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Yes
No
I give my child permission to participate in the Boys & Girls Club of South Logan County Soccer League. I fully understand the physical nature of this athletic activity, and I will not hold the Boys & Girls Club of South Logan County responsible for any injury that may occur. Please type your name as consent.
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Date (format Month / Day / Year Example 01/01/2020)
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Thank you for allowing your child to participate in our soccer league. We emphasize having fun while learning and playing a sport which also provides an excellent level of outdoor, physical activity.
For caring adults who are willing to lead by positive example and enjoy working with children, we offer opportunities to volunteer as coaches, assistants, line judges, field setup and takedown, and concessions.
Choose Any
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Coach
Assistant Coach
Line Judge
Field Setup
Take Down
Concessions
Soccer Field Mowing
COVID-19 Activity Waiver
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization.
COVID-19 is extremely contagious
and has significant person-to-person spread. As a result, federal, state, and local governments and federal and state health agencies have recommended social distancing measures and have, in many locations, required ongoing prohibitions on the congregation of groups of people of various sizes.
Boys & Girls Clubs of South Logan County (“Club”) has put in place preventative measures to reduce the spread of COVID-19. These include, but are not limited to, social distancing, wellness monitoring, increased sterilization, required hand-washing, etc. However, the Club
cannot guarantee
that you or your child(ren) will not become infected with COVID-19. Further, attending the Club
could increase
your risk and your child(ren)’s risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Club, or its activities or programs and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Club or participation in Club programming (“Claims”) or activities. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.
Please type your name as your signature and consent to the COVID-19 Activity Waiver
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First
Last
Date (FORMAT MONTH/DAY/YEAR EXAMPLE 01/01/2020)
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IF THERE IS ANY ADDITIONAL INFORMATION YOU WOULD LIKE US TO KNOW PLEASE PROVIDE HERE
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