Soccer – Brown County Parks & Rec

Registration deadline is July 16th

If you prefer to register in person please print, complete and return
this form to our office.

Register Online

Select Activity *

(Age as of July 31st)

Participant's Name *

Age *

Sex *

Grade by Fall 2021

School *

Date of Birth *

mm/dd/yyyy

Years in Program

Parent/Guardian Name *

Mailing Address *

City *

State *

Zip *

Primary Phone *

Emergency Contact Phone *

(if parent/guardian cannot be reached)

Shirt Size *

IMPORTANT INFORMATION, PLEASE READ & CONSENT BELOW.

LIABILITY RELEASE: By signing below I, as a participant or legal guardian representing a minor participant, agree to release the Brown County Parks & Recreation ("BCPR") department, its officers, employees and volunteers from all liability for accidents, injuries, illnesses (including but not limited to unknown risks/exposure to COVID-19), loss of and/or damage to my/our person or property that may arise out of my/our participation in, or my/our presence at the above activity(s). I/We are aware that there are certain risks or possible dangers in participating in this activity. I have entered into this agreement of my own free will. MEDICAL RELEASE: In case of illness or accident, permission is granted to take the above person to the hospital or doctor’s office for medical attention. CODE OF ETHICS RELEASE: As a participant or spectator, I (we) agree to abide by, follow and comply with the rules, policies, and expectations of the BCPR programs and will conduct myself (ourselves) in a courteous and respectful manner by exhibiting good sportsmanship and being a positive role model for youth. I (we) also understand that failing to do so will constitute grounds for sanctions and/or dismissal of participant from the program. PICTURE RELEASE: I, as a participant or legal guardian representing a minor participant agree to allow BCPR to use pictures taken at events for promotional purposes.

I would like to HELP: **To Ensure Player Safety a background check will be done on all Coaches and Assistants

Coach

Assistant Coach

Sponsor, Fee -$175.00

Comments or Medical Information

Additional Child

Price

Signature (Type Name Here) *

By signing this form you agree to the hold harmless/liability release stated above.

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Soccer updates

Youth Soccer

Our soccer program consists of five divisions, ages 3-4, 5-6, 7-8, 9-10 and 11-13.
Registration deadline is in Mid July.
There will be no switching teams after being assigned to one. NO EXCEPTIONS! Games will begin Mid-August and will be played at Deer Run Park.