LJSC Online Registration

	Online Registration

Last Update: June 21, 2007

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Online LJSC Registration Form -- 2010/2011 Season

Please fill out this form and press Submit form to Registrar when finished. Your registration will be automatically emailed to the LJSC Registrar. Fields marked * are required fields that need to be filled before you will be able to submit the form.

Player Information:

First name:

Last name:

Gender:

Male Female *

Birth date:

Home Address:

Street:

Has this child registered to play soccer with LJSC before?

Yes

Town:

Zip:

Parent/Guardian Information:

First name:

Last name:

Relation:

Home Phone:

Work Phone:

Email address:

First name:

Last name:

Relation:

Home Phone:

Work Phone:

Email address:

Medical Information :

Primary Medical Insurance

Company:

Policy #:

Pertinent Medical Information - if none then please state

Allergies:

Medications:

Other Info:

Emergency Contact in Addition to those listed in the Parent/Guardian Section

Name:

Phone #:

Relation:

Age Grouping Determination:

The team your child plays on is normally based on your child’s birth date. Please review the listing below to determine which age group your child will be assigned to:

Birth Date Criteria

Age Group

ages 4-5

Kindergarten

born on or after 8/1/2002

born on or after 8/1/2000

U10

born on or after 8/1/1998

U12

born on or after 8/1/1996

U14

If your child was born between August and December, he/she may want to play in the next higher age group to be with friends. Please indicate if you want your child to play at the next higher age group….

Uniform Sizes:

Please go to the Age group you child will be playing in and select the appropriate size(s) for her/him.

K- U8 group --

Tee Shirt:

U10/U12/U14 --

Jersey:

Shorts:

Socks:

Fees:
Fees are determined by Age Group, whether you will be participating in the candy fundraiser, when you are registering and how many children you are registering to play soccer.

	Registration Fee:		$ * Choose one option
		Families with 3+ players only pay for the oldest two children. If this is the case, then please choose the $0 - third child of 3+ player family.

	Fundraising:		$ * Choose one option

		Late Fee:	$ * Choose one option

		Total:	$ * Calculate your total and type it in the box to the left


		Please make checks payable to LJSC and mail to PO Box 90, Lebanon, CT 06249

Volunteering:

We are always in need of help during the Fall season. Please specify the areas in which you can help ….

Position:

Age Group:

Gender:

Male

Female

Other volunteering:

Note:

Occasionally we post team pictures and actions shots on our web site. If you do not want your child’s picture to be included in such posts please check here ….

Please remember to send fees and a copy of the player’s birth certificate (only needed for first time registrants) to LJSC, PO Box 90, Lebanon, CT 06249. A child will not be considered registered until all forms, documents and fees have been received. Once a child has been placed on a team, you will be asked to sign a medical release statement by the coach. This release must be signed before your child can practice or play.



	Please be patient - the submittal process takes about a minute to complete ...