Registration

Putnam Impact Soccer Club
 
 

Putnam County Resident Fee: $250

Out of County Residents fee: $300

(Registration Fee includes Uniform)

 

All money is due by July 20, 2018 unless otherwise agreed upon. No uniform will be ordered until payment has been received in full. (By clicking the submit button you agree to the payment terms.)

Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Home Address *
Home Address
We ask this for carpooling purposes.
Mailing Address
Mailing Address
If different than home address
Mother's Name/Guardian
Mother's Name/Guardian
Mother's Phone
Mother's Phone
Father's Name/Guardian
Father's Name/Guardian
Father's Phone
Father's Phone
Emergency Contact *
Emergency Contact
Other than parent
Emergency Contact Phone
Emergency Contact Phone
Youth Sizes YXS 6 - 8 H: 50" - 51" W: 56 - 65 lbs. YS 8 - 10 H: 52" - 54" W: 66 - 75 lbs. YM 10 - 12 H: 55" - 58" W: 76 - 85 lbs. YL 14 - 16 H: 60" - 62" W: 86 - 95 lbs. YXL 18 - 20 H: 63" - 66" W: 96 - 105 lbs. YXXL Adult Small H: 67" - 69" W: n/a Adult Sizes Small Medium Large X-Large
Youth Sizes YXS 6 - 8 H: 50" - 51" W: 56 - 65 lbs. YS 8 - 10 H: 52" - 54" W: 66 - 75 lbs. YM 10 - 12 H: 55" - 58" W: 76 - 85 lbs. YL 14 - 16 H: 60" - 62" W: 86 - 95 lbs. YXL 18 - 20 H: 63" - 66" W: 96 - 105 lbs. YXXL Adult Small H: 67" - 69" W: n/a Adult Sizes Small Medium Large X-Large
XS: 9C-1Y Youth Shoe Size S: 13C-4Y Youth Shoe Size M: 4Y-6 Youth Shoe Size, 5-9.5 Women's Shoe Size, 5-8.5 Men's Shoe Size L: 10-12 Women's Shoe Size, 9-13 Men's Shoe Size XL: 12-16 Men's Shoe Size

Putnam Impact Soccer Photo Release Form

The Putnam Impact and its representatives will take many pictures of the players and coaches throughout the year to illustrate, for you and them, the many activities in which they are engaged.

These images may be used for promotional or publicity purposes and may be published in mass media publications or on social media.

By clicking the I Agree button below, I grant permission to the Putnam Impact to capture my child’s image during soccer-related activities, which may appear in the forms described above.

I hereby release and discharge Putnam Impact from any and all claims and demands arising out of or in connection with the use of the photographs, including without limitation any and all claims for libel or invasion of privacy.

I do this willingly, expecting no compensation or gratuity of any kind from Putnam impact.

Player's Name *
Player's Name
Parent's/Guardian's Name
Parent's/Guardian's Name
Best Phone
Best Phone