Text Box: MSI TOPSoccer is a soccer program for junior athletes in elementary through high school years that is a partnership between SOMO and MSI Soccer. Go to www.msisoccer.org to see all of the details about the program.

MSI TOPSoccer  / The Special Olympics Montgomery Junior Soccer Program

MSI TOPSoccer Program Registration for Fall 2007 can be completed online at msisoccer.org or by mailing this completed form and fee ( check made payable to MSI TOPSoccer).                                                         Mail to: Pam Yerg 10204 Colebrook Ave. Potomac MD 20854.

The MSI Administrative fee for the program is $25.00. Financial aid is available. Season begins            Sunday, September 16 and runs through October 21 with a TOPS Tournament in early November    details TBA. Training location: Grace Episcopal Day School—9411 Conn. Ave in Kensington.

Elementary players: 12-1:00  Middle School and High School players: 1:00-2:30. * We are currently working on the development of a high school league and details will be announced on the

somdmontgomery.org and msisoccer.org websites  in  mid-August.

 

Player Information ( please print)

Name:_______________________________________________________________________________

 

Address:_____________________________________________________________________________

City:____________________________________________Zipcode:_____________________________

DOB:______-______-______ Grade in school:______    School:_______________________________

Family Email: _________________________________@______________________________________

Home Phone: (_______)_____________________ Cell Phone: (______)_________________________

Description of disabilities/special needs :

 

_________________________________________________________________________________

MSI 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 all; and the risk of injury due to uneven surface. I understand also that not all volunteers working with the TOPSoccer Program may not have had specialized training in working with children with disabilities. I agree to assume those risks, and agree that Special Olympics MD-Mo, 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:__________

 

For online registration or more program information go to www.msisoccer.org