Howell Revolution Soccer Club by pengtt


 Howell Revolution Soccer Club (HRSC) • • 517-552-8768

                          Registration Day Checklist

Registration Day: Monday, June 23, 2008 – Boys- 6:00 PM, Girls- 7:30 PM
Location: Page Field / Barnard Center, Room 1 (415 N. Barnard, Howell MI 48843)

Please Bring The Following Items To Registration For Each Player:

       Player AND Parent or Guardian
       Note: The player must be present to sign a Passcard and other documents. A parent or guardian
       must be present to sign medical release forms, player contracts, etc.

       This Form Packet
       Note: To streamline the registration process, please fill out all forms in this packet before your
       scheduled Registration Day time.

       Required Fee
       Note: Check or Money Order accepted. See ‘2008/2009 Player Costs Estimate’ sheet for amount
       due. Make check payable to: HRSC.

       Birth Certificate
       Note: All personal information can be removed except for name and birth date. Photocopies are

       Small photo of player for pass-card
       Note: Photo should not be bigger than 1 ½” x 1” (wallet size or smaller). Please write player’s name
       on the back of picture.

       Medical Insurance Information
For questions: Contact Howell Revolution Soccer Club (HRSC) 517.552.8768

                                     Please Note!
If you can not attend Registration Day, contact your Coach immediately to make other
arrangements. Failing to properly register will result in removal from your team!
       Howell Revolution Soccer Club (HRSC) • • 517-552-8768

                                         2008/2009 Player Registration
  Seasons (dates are approximate): Fall: 9/8/07 – 10/28/07              Spring: 4/5/08 – 6/8/08

  Start of Season / Practice: Coaches will contact all players before start of each season. Practice normally
  starts 2 – 3 weeks before start of season.

  Travel: Home games will be played at Page Field in Howell. Away games will typically be played in the Metro
  Detroit Area.

  Game Days: Varies by age group. Saturday or Sunday games are typical. Occasional evening weekday
  games are possible.

  Uniforms: All players will require a HRSC club uniform kit (game & alternate jerseys, shorts, and socks). You
  may purchase extra jerseys, shorts, and socks if desired. Uniforms are used for multiple seasons.

  Birth Certificates: All players are required to submit a birth certificate for age verification. All personal
  information, other than player name and birth date, may be removed. Photocopies are acceptable.

  Training Fees: See the 2008/2009 Player Costs Estimate sheet for your team.

  Other Costs: Depending on the team, there may be other costs (tournament fees, indoor fees, etc.) required.
  These costs will be collected by the coach when needed. See the 2008/2009 Player Costs Estimate sheet for
  your team.

  Payment Schedule: See the Player Costs Estimate sheet for your team.

                     Please Print Legibly
                                                              Registration Cost:                                        Cost
                                                                     Fall Season                                         $150
                                                              Equipment Cost (Uniform, etc.):

Player Name                                                          Amount from Equipment Order Form

                                                                                                             Total =
                                                              Method of Payment:
Address                                                            Money Order (Make Payable To: HRSC)
                                                                   Check (Make Payable To: HRSC)            Chk #

City                                 State       ZIP
                                                              Howell Revolution Soccer Club (HRSC) Waiver
                                                              I parent/guardian, hereby waive any or all rights, claims for
                                                              damage arising from injury received while my child is playing,
Birth Date             Male or Female (M/F)
                                                              walking, or being transported to tryouts, practices, games or other
                                                              league or HRSC activities. I also hold harmless Howell Revolution
                                                              Soccer Club (HRSC), its directors, organizers, coaches, sponsors,
Phone Number                                                  managers, or any other supervisor appointed for any injury
                                                              incidental to the activities or transportation to and from these
                                                              activities. I also agree to allow HRSC to use and reproduce the
                                                              participant’s name and/or likeness to circulate the same for any
Email Address (Note: HRSC does not sell email addresses)      and all promotional purposes. I certify that the information on this
                                                              form is correct.

                       Office Use Only

  Date:              Receipt #:                 Initials:
                                                              Parent/Guardian Signature
         Howell Revolution Soccer Club (HRSC) • • 517-552-8768

                                       Player Equipment Order Form
Date: _____________________                                                     Uniform #: ___________________
                                                                                             (Assigned By Coach Only)

 Team: U-____               Girls               Boys            Red                  Blue             White             _______

Player Name: ___________________________________ Phone Number: __________________

Parent/Guardian Name: __________________________________________

Address: ______________________________________________________

Please Note: All players are required to have one complete 2008/2009 style uniform kit. A complete kit consists
of a Jersey and Alternate Jersey, Shorts, and Socks. Since uniforms are used for multiple seasons, it is not
required to buy a new uniform kit every season. If you are not sure whether or not you need a new uniform, ask
your Coach. You may purchase as many items as desired.

  Item              Youth Size                            Adult Size                  Quantity          Cost             Cost
                  (Circle Correct Sizes)               (Circle Correct Sizes)                           (Each)

 Jersey      S        M          L         XL      S       M         L          XL     Required
                                                                                                  X    $30.00    =

Alternate                                                                                 1
 Jersey      S        M          L         XL      S       M         L          XL     Required   X    $30.00    =

 Shorts      S        M          L         XL      S       M         L          XL     Required   X    $15.00    =

 Socks                  Youth                                  Adult                   Required   X     $5.50    =

Warmups      S     M         L         XL          S      M         L           XL                X    $85.00    =

                                            Backpack                                   Optional   X    $33.00    =

                                                                                                      Total Due =

                 Please make check payable to: HRSC. Payment is due on Registration Day.
Howell Revolution Soccer Club (HRSC) • • 517-552-8768

                   Player/Parent Contract 2008/2009 Season

    1. By signing this contract the player and the player’s parent(s) or guardian(s) agree that the
       player is committed to play the 2008/2009 soccer season with their Howell Revolution
       soccer team. Once this commitment is made a player cannot change teams without
       obtaining a signed release form from the Howell Revolution Soccer Club (HRSC)
       Executive Committee. The player may be a guest player on another team in a
       tournament; however, the player’s first commitment is their Howell Revolution soccer

    2. If my conduct at any HRSC function, practice, or game is inappropriate or reflects
       negatively on the team or HRSC, I may be asked to leave by the head coach, assistant
       coach, or team manager. If I refuse, HRSC may take further action. I will treat all
       referees with the utmost respect regardless of their perceived competence. I will display
       the highest level of sportsmanship at all team activities. I will respect the opposing
       team’s players, coaches, staff, and spectators. Players and parents who do not follow
       this code of conduct will be subject to disciplinary action, including possible dismissal
       from the team.

    3. I understand that my Howell Revolution soccer team does not wish to discourage players
       from participating in other sports or activities during the soccer seasons. However,
       attendance and participation at practices and games is mandatory, unless a pre-excused
       absence is obtained from the head coach or team manager. It is the desire of the Howell
       Revolution soccer team to work with dedicated soccer players in helping them attain the
       highest level of play possible. This cannot be accomplished if there are absences from
       practices or games. If there is a problem in getting to a practice or a game, parents must
       let the coach know well in advance.

    4. I understand that while it is the coaching staff’s goal to provide all players with an equal
       amount of game playing time, I also understand that there is no guarantee of equal
       playing time. Playing time for each player is earned and is at the sole discretion of the
       head coach, within the rules of the league in which the team is playing. Playing time may
       also be restricted based upon disciplinary action.

    5. I understand that we are expected to be prompt at practices and games. I understand
       that the team will play approximately four to five home games and four to five away
       games, mostly on weekends with the possibility of a few weekday games. The team will
       generally travel the Southeast Michigan area. I also understand that the team may
       participate in tournaments and indoor soccer during the winter.

       Player Name (Print)      _________________________________                 Date    __________

       Player Signature         _________________________________                 Date    __________

       Parent Name (Print)      _________________________________                 Date    __________

       Parent Signature         _________________________________                 Date    __________
                                 THIS FORM MUST BE PRINTED OR TYPED
                  MSYSA STATE OFFICE - 9401 GENERAL DRIVE, SUITE 120, PLYMOUTH, MI 48170.

                                               SOCCER MEDICAL RELEASE

I hereby give my permission for any and all medical attention necessary to be administered to my child,

                                                         (INSERT CHILD’S NAME)
In the event of accident, injury, sickness, etc., under the direction of the person(s) listed below, until such time as I may be
contacted, this release is effective for a period of one year from the date given below. I also assume the responsibility for the
payment of any such treatment, including, but not limited to transportation for required treatment.

Home Phone:
Office Phone:
Cell Phone:
Name of Insurance Company:
Policy Number:                                                                              Type:
In case I cannot be reached, any of the following people are designated to act on my behalf:
  1. Coach.                                                 2. Assistant Coach/Manager
  3. Team Parent                                            4. A league representative where my child is playing
  5. Any tournament representative where my child is participating in a US Youth sanctioned tournament.
In case I cannot be reached, please call                                                            at
Our Physician’s Name:
Phone:                                                                          Hospital:
Known Allergies:
Known Disabilities:
Other Important Medical Information:
Signature of Parent/Guardian & Date:
Subscribed and sworn to before me this                                                              day of
NOTARY PUBLIC:                                                                  My commission expires:
                                 THIS FORM MUST BE PRINTED OR TYPED
                  MSYSA STATE OFFICE - 9401 GENERAL DRIVE, SUITE 120, PLYMOUTH, MI 48170.

                                 PARENT OR GUARDIAN CONSENT TO TRAVEL

Seasonal Year:

Team Official’s Name:

Team Name:

League Name:

Age Group:


Player’s Name:

          My child has permission to travel with you, as chaperon to various tournaments where he/she will participate in, among
          other things, soccer in various modes of transportation, accommodations, meals, and physical activities in addition to
          playing soccer.
          I further acknowledge that our child participates in the trip at his/her own risk. Our child is in good health, and we release
          you, your heirs, executors and assigns of any responsibility that you or they might have regarding the health and physical
          condition of our child during his/her participation in the trip. On behalf of myself, our child, our heirs, executors and
          assigns, I further release and forever discharge you, your heirs, executors and assigns, and demands right or cause of action
          of whatsoever kind of nature, either in law or in equity, arising from or by reason of any bodily and/or personal injury
          sustained by our child and/or lost or damaged property, or otherwise, directly or indirectly arising from participation by my
          child on the trip.
          I agree to indemnify you, your heirs, executors and assigns, and any chaperons, their heirs, executors and assigns on
          account of any claims that might be asserted by myself or by my child. Permission is given to take any action you may
          deem necessary in the event of injury to or illness of my child and for any emergency anesthesia and/or operation which
          might become necessary, which action shall include the giving of permission to any doctor to hospitalize, provide proper
          treatment, and order injections, anesthesia or surgery for my child.

Parent or Legal guardian’s Signature                                                             Date
Howell Revolution Soccer Club (HRSC) • • 517-552-8768

                      Volunteer Sign-Up 2008/2009 Season
 Please help the club by sharing your talents, time, or resources. If you are
 interested in organizing or simply helping out on one or more of the items listed
 below, please let us know. If there is something that you would like to suggest
 but is not listed, please ‘fill in the blank’. Thank-you for your support.

 Check A Box – Help Your Club
            Collect and process uniform orders. Pick-up and delivery to teams.

            Fundraising committee – Organize or participate in club fundraisers.

            Spirit wear – Organize or participate in club spirit wear event

            Assistant to the club Registrar
            Director of Marketing – Organize and market the club, corporate
            Organize Revolution teams to participate in the Howell Melon Run

            Organize or work on float for Fantasy of Lights parade

            Park cars at Howell Balloon Fest

            Work at try-outs

            Organize or work at golf outing

            Organize or work on Soccer Field Development Committee


 Phone Number:

 Best Time To Call:

 Coaches Name:

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