Microsoccer – U15
Heartland Futbol Club
To register, complete this form, include payment and mail to:
Heartland Futbol Club
P.O. Box 5584
Grand Island, NE 68803
Additional club information is available at www.heartlandfcgi.com / CLUB USE ONLY
Paid $ ______
Check#: ______
Rec’d: ______
Entered: ______
TID: ______
PLEASE PRINT LEGIBLY AND COMPLETE ALL PORTIONS OF THE FORM. ALL INFORMATION IS MANDATORY IN ORDER TO PLAY.
PLAYER INFORMATION
PLAYER’S NAME / GENDER / DATE OF BIRTH / MOTHER’S BIRTHDAY Male
Female / ______/______/______
Month/Day/Year / Required for unique playerID
______/______
Month/Day
STREET ADDRESS / CITY/STATE / ZIP
EMAIL (ONLY USED FOR SENDING SOCCER CLUB INFORMATION) / HOME PHONE / CELL PHONE
AGE DIVISIONS/BIRTHDATES (Divisions subject to change based on #’s) / VOLUNTEERS NEEDED / FEE
___ Microsoccer
___ U6
___ U7-U8
___U9-U10 Boys
___U9-U11 Girls
___U11-U12 Boys
___U12-U14 Girls
___U13-U15 Boys / 1/1/2012 TO 09/30/13
1/1/2012 TO 12/31/2012
1/1/2010 TO 12/31/2011
1/1/2008 TO 12/31/2009
1/1/2007 TO 12/31/2009
1/1/2006 TO 12/31/2007
1/1/2004 TO 12/31/2006
1/1/2003 TO 12/31/2005 / It takes volunteers to make yourchild’s soccer experience a success. Please consider how you can best help. Indicate positions of interest:
Head Coach*
Assistant Coach*
Referee – this is a paid position; however, certification is required.
Name:______
Phone: ______
Email: ______
* Coaches are subject to review/approval of the board each season and subject to the NSSA’s KidSafe program. / Fall-Only Fee .. $65
Full-Year Fee .. $90
(Fall & Spring seasons)
REFUND POLICY: No refunds will be issued under any circumstances, except in situations of documented medical injuries (subject to board approval).
UNIFORM INFORMATION / REGISTRATION
SIZE (PLEASE DO NOT INDICATE A NUMBER FOR SIZE. SELECT ONE OF THE LISTED OPTIONS) / Youth:
□Extra Small
□ Small
Med.
Large
Adult:
Small
Med.
Large
XL
XXL / All registrations postmarked after June 15, 2017 will only be accepted if there is roster space available.
Make checks payable toHeartlandFC. There is a $25 charge for all returned checks.
Registration form and money will be returned if the form is incomplete.
REGISTRATION
LIABILITY WAIVER:
I agree to allow my child to play soccer under the control and organization ofHeartland FC. I agree to holdHeartland FC, its officers, directors and coaches free from any and all liability to the named child arising out of his/her participation including travel to and from practices and games. Coaches, managers, referees, their assistants or anyone who prepares any playing field shall not be liable for any injury or death of any participant in Heartland FC, which results from the negligence of any of the above listed individuals. I also agree to let Heartland FC take photos of my child and use them in support ofHeartland FC. By signing this waiver, I agree to these terms.
SIGNATURE/DATE OF ALL PARENT(S) OR GUARDIANS(S) / PRINT NAME(S) OF ALL PARENT(S) OR GUARDIANS(S)ABOUT HEARTLAND FC:
Heartland FCis mostly comprised of volunteers, which includes a Board of Directors. The board meets on the second Wednesday of each month. Heartland FC is sanctioned through the Nebraska State Soccer Association. Heartland FC is for Preschool to U15 ages,and is designed for giving players the opportunity to play and learn. The fall season runs from late August to mid-October. The spring season is conducted from late March through mid-May. Games are generally scheduled for weekends.
HEARTLAND FC SOCCER BOARD
Positions on the soccer board include: President, Vice-President, Secretary, Treasurer, Registrar, Director of Coaching, Marketing/Financial Coordinator, Recreational Representative, Academy Representative, and Past President/Special Advisor. Board positions are elected at the annual board meeting held in November of each year. If you are interested in becoming a board member, please attend a board meeting or indicate your interest in the volunteer section of the registration form.
REFEREES
Whether you want to become a new referee or are a current referee looking to re-certify for next year, clinics (training) are available. Individuals interested in becoming a soccer referee can attend a soccer certification class.
You must be 13 years of age on or before March 31 for spring clinics or August 31 for fall clinics. Referees are paid by the league. More information isavailable at giheartlandsoccer.comor at nebraskastatesoccer.org website. For any certification or recertification, you must register at nebraskastatesoccer.org before attending a clinic.
SAFETY GEAR
Wearing of jewelry of any kind as well as castsis not permitted during practice or games. All players are required to wear shin guards covered with socks.
PRINCIPLES AND OBJECTIVES
- Soccer is a game and should be FUN!
- The program is for kids and THEIR enjoyment.
- Displaying good sportsmanship is vital to SUCCESS of the league.
- Coaches should stress FUNdamental skill development of each player.
- The GOAL is for all players to play as close to equal playing time as possible.