North Brunswick Soccer Club

Buddy Ball Division

Fall 2021 Registration Form

Email to:  

Opening Day is Saturday, September 11, 2021 @ 10:00 a.m.

Child’s Name (Player)_____________________________________________________

Address:  _______________________________________________________________

        Street                                                City State Zip

Home Phone:  _____________________    Date of Birth ___/___/___  Gender __M __F

Dad’s Name:  ______________________  Mom’s Name: ________________________

Child’s Shirt Size: (circle one)  Child    Sm   Med Large   or Adult    Sm  Med Large

Email Address:  __________________________________________________________

Emergency Information

Doctor’s Name:  _____________________________  Doctor’s Phone: ______________

Emergency Contact & Phone:  _______________________________________________

Parent/Guardian Signature:       _______________________________________________

Please indicate your child’s special needs and any information we may need to know to provide

him/her with a good opportunity and experience:  _____________________________________

Notes: