Montgomery Soccer, Inc.—S.O.M.O Juniors TOPSoccer Registration

 

The TOPSoccer Program is a partnership between MSI and Special Olympics Montgomery JUNIORS  programs. You do not need to be a registered Special Olympics athlete in order to register for

TOPSoccer.

Fee: $25.00*  Financial Aid is available. The fee charged covers MSI expenses to facilitate this program.

                       Mail completed form and  fee to:

Pam Yerg –TOPS-  Montgomery Soccer, Inc.

10204 Colebrook Ave. Potomac MD 20854.

Season  begins Sunday, September 17  through Nov. 5  No TOPS Sept.24th ( Holiday)

The TOPS Tournament will be hosted by  the Maryland SoccerPlex - Date TBD 

NEW* Training Location: Luxmanor Elementary School – Tilden Lane- Rockville

Elementary Players 12-1:15 / Middle School players: 1:30-3:00

*Players are loosely divided into age and experience groupings.

 

Player Information (Please Print )

Name:  Last Name                     First Name                       Middle Initial

 

______________________________________________________________________________

Address:________________________________City:_____________________Zipcode:_________

    

DOB:____-____-______    Grade in School:______   School:______________________________

 

Home Phone: (_____)____________________________ Family Cellphone: (_____)_____________________

Family E-mail Address                                   Work Phone (Father/Mother)             Extension

_____________________________@_____________     (   _____)-_______________      _______

 

 

 RELEASE

I, the parent or guardian of _________________________   (the player) give my permission for the player to participate in MSI’s TOPSoccer Adaptive Soccer Program (the Program). I acknowledge the risks of physical harm to the player as a result of his/her participation.  I understand that, among other risks inherent in participation by the player in a strenuous physical activity, there particularly exist the risks of collisions and confrontations between players, between players and officials, and between players and field equipment or adaptive soccer equipment; the risk of being struck by a kicked or thrown soccer ball; and the risk of injury due to uneven playing surface.  I understand also that not all volunteers working with the Adaptive Soccer Program may have specialized training in working with children with disabilities. I agree to assume those risks, and agree that MSI, its volunteers, and its employees assume no liability for injuries arising from the player’s participation.

       I hereby represent that, to the best of my knowledge and belief, the player is physically and mentally able to participate in the Program and has had, or will have, any necessary physical examinations before participating.  I further acknowledge that MSI is relying on these assurances in determining whether the player may participate in the Program.

       If a medical emergency should arise in my absence during the player’s participation, I authorize a representative of MSI to consent to emergency medical treatment of the player on my behalf.

 

 (Parent/Guardian Signature)  ______________________________________ Date___________

ONLINE REGISTRATION for TOPSoccer will be available by the end of August.

Visit www.msisoccer.com

Go to programs and TOPS or mail in this registration form with payment to Pam Yerg.