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 7 through Friday, Nov 9
  • 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: I acknowledge I am the player and the person executing this Waiver. In consideration for Penn Legacy Adult Soccer's acceptance of Player’s registration, and before participating in a Penn Legacy Adult Soccer program or participating in any activity on a Penn Legacy owned/leased facility, I agree to the following on behalf of myself, and my family: 1. There are inherent risks in participating in the sport of soccer, including serious injuries and even death. These risks can happen, regardless of the level of care taken by the participant and/or the organizers. 2. I knowingly and freely assume all risks of personal injury, property damage, or any other loss while participating in all activities related to Player’s participation in the program, even if due to negligent behavior of Penn Legacy and/or its members, staff, club contractors and representatives, or officers. 3. I agree that the Player will be bound by and comply with the rules and regulations of Penn Legacy Adult Soccer and the program and will be subject to exclusion in the event of noncompliance, as determined necessary by Penn Legacy, in their sole discretion. 4. I hereby authorize Penn Legacy officers and coaches, if after a reasonable attempt has been made to reach an emergency contact to obtain consent, or if sound medical practice decrees that there is not time to make such an attempt, to consent to any emergency medical treatment. I acknowledge that the registration and registration fee do not include accident insurance coverage. I agree to pay for any such treatment and to reimburse Penn Legacy for all costs and expenses.

* 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