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Registration Form

Completed registration, medical release forms,
proof of age, and tournament fee are due by January 16th, 2004 to guarantee T-Shirt.
ALL FEES ARE NON-REFUNDABLE

Entry fee of $100.00 must accompany forms payable to;
Coastal Soccer Club

Mail To;
Coastal Soccer Club
3946 Spanner Way
Murrell's Inlet, SC 29576

Team Name:_______________________________________________

Contact Name:_____________________________________________

Contact Phone Number:______________________________________

Contact Address:____________________________________________

Contact Email:______________________________________________

Team Skill Level:    Recreation____    Competitive____

Team Gender:    Male____     Female____

Age Group: 
(The age of the player on the date of the tournament will dictate the lowest division he/she can compete in.)
Under 8_____
Under 10____
Under 11____
Under 12____
Under 13____
Under 14____
High School Division (Age 15 - 19)____
Open Adult Division____

Player 1:_____________________________  Date of Birth:_______________

Player 2:_____________________________  Date of Birth:_______________

Player 3:_____________________________  Date of Birth:_______________

Player 4:_____________________________  Date of Birth:_______________

Player 5:_____________________________  Date of Birth:_______________

T-Shirt Sizes:  Player 1____  Player 2____  Player 3____  Player 4____  Player 5____

Medical release forms & proof of age must be completed by all participants  
and submitted with registration and tournament fee.
Late Registration Entry Fee is $125.00
ALL FEES ARE NON-REFUNDABLE

Medical Release Form
(Players under age 18)

Player Name:_________________________________

Birthdate:_____________________  Age:___________  Gender:____________

Parent/Guardian Name:_______________________________________

Parents/Guardian Address:_____________________________________

Emergency Phone Numbers:__________________________________________

Any Known Allergies:_______________________________________________

Recognizing the possibility of physical injury associated with soccer and in consideration for Coastal Soccer Club and its affiliates.  I hereby release, discharge and/or otherwise indemnify Coastal Soccer Club, its affiliated organizations and sponsors, their officers, volunteers and associated personnel, including the owners of the fields and the facilities utilized, against any claim by or on behalf of my child's participation in the tournament and/or being transported to and from the same.  My child has received a physical examination by a physician and has been found physically capable of participating in the sport of soccer and by extension this tournament.

Therefore, I grant______________________ and/or ____________________ permission to act as my surrogate for my child in the area of obtaining medical treatment by a doctor of medicine.  I also assume the financial responsibility for any medical treatment for my child.

Signature of Parent/Guardian:________________________ Date:___________ 

Medical Release Form
(Players over age 18)

Player Name:_________________________________

Birthdate:_____________________  Age:___________  Gender:____________

Emergency Phone Numbers:__________________________________________

Any Known Allergies:_______________________________________________

Recognizing the possibility of physical injury associated with soccer and in consideration for Coastal Soccer Club and its affiliates.  I hereby release, discharge and/or otherwise indemnify Coastal Soccer Club, its affiliated organizations and sponsors, their officers, volunteers and associated personnel, including the owners of the fields and the facilities utilized, against any claim by or on behalf of my participation in the tournament and/or being transported to and from the same.  I have received a physical examination by a physician and have been found physically capable of participating in the sport of soccer and by extension this tournament.