Penn Legacy Adult Registration

Penn Legacy Adult Rec League - Over 30 Registration

Fall Mens Rec League:
  • Men's Over 30 Rec League - Starts Friday, Sept 8 through Friday, Nov 10
  • Weekly games on Friday evenings between 6:30 and 9:00 pm
  • Location: Hempfield High School "Quad"
  • Please Read:
    When registering - please consider donating to our ALL KIDS PLAY FUN'D which supports our Penn Legacy Futures Program for ages 3 through 8 which allows kids in need to play FREE. The value is $85 per child.

    We rely on donations and sponsors to help this program remain free and so that all kids can play the game of soccer.

    Thank you!

Name:* first last
Address:*
City:* State:*     Zip:*
Home Phone: format: 999-999-9999
Cell Phone:* format: 999-999-9999 if no cell then enter n/a.
Email:*
Provide an email you will check regularly during the season.
Confirm Email:*
Date of Birth:* / /
Shirt Size:

Soccer Information

Goal Keeper Info:
Highest Level of playing experience:
Self Rating:
Total Years playing experience:
Preferred position:
One player request per player is allowed but both players must request each other. This is in an effort to more evenly distribute teams. We will also have team captains who will help select rosters to ensure all teams are rostered as evenly as possible so that teams are as competitive as possible.
I would volunteer to be a team captain (responsible for contacting team with important updates or info) : Yes
No

Emergency Infomation

Emergency Contact:
Emergency Phone:
Insurance Company:
Physician Name:
Physician Phone:
List any medical conditions or prohibitions: * if no Health Concerns, please enter NONE


Fee

Adult League fee $. Please consider donating to the ALL KIDS PLAY fund which will ensure that all kids continue to enjoy a quality soccer experience. Donors will be posted on the website*

Adult Fee plus $25 donation (total $120) 
Adult Fee plus $50 donation (total $145) 
Adult Fee plus $75 donation (total $170) 
Adult Fee plus $100 donation (total $195)
Adult Fee only (total $95)                          

Payment Method: * Credit Card  
All fees are non-refundable.

As a condition of your participation in the Hempfield Soccer Club’s Penn Legacy Adult Recreation League, you hereby agree to the following: 1. You acknowledge that participation involves activities that may be hazardous or physically strenuous. You agree that you have been advised to obtain the advice of a physician before you engage in this physical activity. You undertake these activities voluntarily and with full knowledge of the risks involved and the potential for injury. You agree to accept any risk of injury, loss of any kind or even death. 2. You hereby release, indemnify, and hold harmless the Hempfield Soccer Club’s Penn Legacy Adult Recreation League and all affiliated associations, and its and their organizers, directors, representatives and participants from any and all claims and/or liability arising out of injury to yourself while participating in league activities.

* I/WE HAVE READ THE ABOVE.
My electronic signature (after the “s/” below) indicates my agreement with the statements set forth above and my consent to be bound.
Please enter your First and Last Name: *s/

* Required field