Player Registration Form - Fall 2015
Online registrations must be paid via credit card

Any questions regarding online registrations contact 

Fields in red are required
Players First Name:  Middle Initial:
Last Name: 
  City: State:ZipcodeAreaCodePhone#
 Confirmation will be sent to this email address

Primary Email:

Confirm Email

Date of Birth Gender:Male Female

This Player Registering for

Travel players must attend at least (1) tryout date in order to be considered for selection on a travel team.
Travel Registration fee does not include uniform fee, uniforms will be purchased through each travel team's coach.
Age as of 7/31:
School Currently Attending Current Grade
The Washington Township Soccer Advisory Board and the travel soccer program rely on the fundraising and volunteer efforts of its board, coaches, and parents. By registering to play travel soccer I agree to participate in all Soccer Advisory Board fundraising activities and to provide a minimum of two hours of volunteer effort per child for each season my child(ren) play travel soccer for Washington Township. While it is anticipated the majority of this volunteer requirement will be for the annual tournament, the assignment of volunteer work will be at the discretion of Soccer Advisory Board.
I agree to meet the minimum volunteer requirement

Comments or Special Requests Use this field if: 1.New to WTPR Soccer, if so please list previous experience. 2.Requesting a specific coach (CLINIC ONLY). 3.Any special needs or requests.
Any special needs or medical condition a coach should know of:
Parent Information

Mother/Guardian- First Name Last Name
Address  Same as Child 
 City:  State:ZipcodeAreaCodePhone#      
Father/Guardian- First Name Last Name
Address Same as Child 
 City:  State:ZipcodeAreaCodePhone#      

Emergency Contact
Name Phone Number

Volunteer Information
Volunteers NameArea CodePhone#
Check all that apply
Do you wish to volunteer as HEAD coach?
Do you wish to volunteer as an assistant coach?

Medical Release Information:
Injuries are inherent to sports; therefore, in the event of an injury, I hereby release the Township of Washington, its officers, volunteers and coaches as well as all sponsors from all liability. I also understand that primary medical insurance is my responsibility if there is an injury. If I am not present, I hereby give permission for any and all medical attention necessary to my child in the event of an accident, injury, sickness, etc.
Check here if you agree
Release :
I/We the parent(s) of the above child hereby give my/our approval for the said child to participate in any and all activities of the Washington Township Recreation Program. I/We assume all risks and hazards incidental to such participation and hereby waive, release, absolve , indemnify, and agree to hold harmless the Township of Washington, its officers, volunteers, coaches and participants from claims for accidents or illnesses arising from participation in the Township of Washington's Recreation Program.
Check here if you agree

Check here if form is complete