RECREATION SOCCER REGISTRATION FORM

Laurel Jones County
Soccer Association
P.O. Box 4424
Laurel, MS 39441
www.ljcsa.com
soccerboard@ljcsa.com
For Official Use Only
Division U – ____________
Gender: Boys Girls
Amount Paid: __________
Check #: ______________
Cash
Verified By: ___________
Birth Certificate: Yes No
RECREATION SOCCER REGISTRATION FORM
New Player to LJCSA? ( circle one ) Yes No
Player: _______________________________________________________ Phone: ______________________
(First Name MI Last Name, Age)
Gender: _______ Birthday: ______/______/______
Contact Email:______________________________
Address: _______________________________________________ Number of seasons played: ______________
Number of seasons as Goalie: ____________
P.O Box: __________________________________________________________
City: __________________________________State: _____________________ Zip:_______________
Father: ___________________________________Work Phone: __________________ Cell:_______________
( First Name M.I. Last Name)
Mother: __________________________________ Work Phone: __________________ Cell:_______________
(First Name M.I. Last Name)
Players who played in the fall and are returning in the Spring please fill out spaces below:
Age Division: ______
Coach: ____________________________________________
Uniform Information: ( Players who played in the Fall will use the same uniform for Spring )
Jersey YOUTH SIZES ADULT SIZES Shorts YOUTH SIZES ADULT SIZES
Y-Small ( ) Small ( ) Y-Small ( ) Small ( )
Y -Medium ( ) Medium ( ) Y-Medium ( ) Medium ( )
Y-Large ( ) Large ( ) Y-Large ( ) Large ( )
X-Large ( ) X-Large ( )
Coaches please list Jersey size: ______________
Registration forms may be mailed, or brought to the Soccer Fields on Registration Day! Please include a
copy of your child’s Birth Certificate! (REGISTRATION IS NOT COMPLETE WITHOUT A COPY
OF THE BIRTH CERTIFICATE)
About Recreational Soccer at LJCSA: LJCSA'S emphasis is: "Everybody Plays" and "Fair Play"
All players will play at least 1/2 of each game.
We want participants to have fun, become physically fit, improve their athletic skills, and learn the value of teamwork
and good sportsmanship.
Soccer Fees: (includes Uniform, Insurance, and LJCSA Membership).
Players will need to bring the following to every practice and game:
Shin Guards
Soccer Ball ( U5,U6,U8 use size #3, U10, U12 use size #4, All others use size #5)
Soccer Cleats (no baseball cleats… soccer cleats are different)
Water Bottle

Field Status updates are available @ 601-319-GOAL and at www.ljcsa.com during the season.
News, Information, Coaches Lists, Rosters, and Schedules will all be posted online when available. You can also sign
up for e-mail updates on our website.
Friends of LJCSA Program:
This program is designed to increase the training that our recreational soccer coaches have access to. The money we
receive from this program will be used to further the training of LJCSA’s Recreational Coaches and young Referees.
100% of the money collected will help LJCSA reduce or eliminate the cost paid by our volunteer coaches and referees
for training, and therefore increase their knowledge and ability to better train LJCSA’s youth soccer players. If you
wish to become a friend of LJCSA please enclose that donation along with your registration fee.
Consent:
I, the parent or legal guardian of the above named child, hereby represent that the child is
in good health and can participate in competitive soccer. I hereby absolutely assume all
risks and hazards incidental to such participation, including transportation to and from,
and release, absolve, indemnify and hold harmless the Laurel Jones County Soccer
Association, its Officers, employees, and all persons and entities associated with LJCSA
from any and every claim, demand, action or right of action, of whatever kind or nature,
either in law or equity arising from or by reason of any injury known or unknown or
death to my child or property damage whether the result of negligence or other cause.
This agreement is given in consideration for my child’s being allowed to participate in the
aforesaid soccer activities. I will furnish a birth certificate of my child upon request by
LJCSA. In the event a parent/coach does not voluntarily step forward to coach the team to
which my child is assigned, I do fully recognize and agree that LJCSA will not participate
in the paying of a coach. Once properly rostered on a team, my child is bound to that team
for the MSA seasonal year unless he/she is legitimately dropped, released, or transferred
from the assigned team.
________________________________________________________________________________
Signature of Parent or Guardian
Date
Make Check payable to LJCSA:
Registration Fee
$___________
Donate to
Friends of LJCSA
($25 or more) $___________
Total Amount
MAIL TO:
LJCSA
P.O. Box 4424
Laurel, MS 39441
$ ___________
Registration forms may be mailed or
brought to the Soccer Fields on
Registration Day!
COACH ( ) ASSISTANT COACH ( ) CONCESSION ( ) TEAM MANAGER ( )
LJCSA is a parent run organization. Without the help and support of the parents there could not be a Soccer
Association. Please choose one of the spaces above to complete this Registration Form.
Page 2 of 2