KPSC Online Registration Form

Complete Form, Click "Continue To Next Step" to pay by credit card, debit card, check or money order.
Click HERE for a List of Frequently Asked Questions
Note: This form is best viewed at 1024x768 px resolution or higher.

Child's Last Name

Child's First Name

Telephone # (xxx-xxx-xxxx)

Street Address

Town

State

Zip Code

Birth Date (mm/dd/yyyy)
/ /

Gender
Boy Girl

Family Email Address

Previous Playing Experience
Yes No KPSC Other:

Last Season Played
Fall Spring Year:

Number of Seasons Played

Parent or Guardian #1: Check if Address is same as Above

Last Name:
First Name:
Street Address:
Town:
State:
Zip Code:
Telephone #:	(xxx-xxx-xxxx)

Parent or Guardian #2: Check if Address is same as Above

Last Name:
First Name:
Street Address:
Town:
State:
Zip Code:
Telephone #:	(xxx-xxx-xxxx)

Name of Present Family Medical Insurance Carrier

Emergency Contact Name

Emergency Contact Telephone # (xxx-xxx-xxxx)

Choose Registration Option

Inter-League (U10 +)

Pre-Travel (U8 / U9)

Travel (U10 +)

Full Year	- $160
Fall	- $95
Spring	- $95

Full Year	- $160
Fall	- $95
Spring	- $95

Full Year	- $190
Fall	- $115
Spring	- $115

Full Year	- $190
Fall	- $115
Spring	- $115

Full Year	- $195
Fall	- $120
Spring	- $120

Full Year

- $195

Full Year	- $295

Spring	- $190

I as a parent and/or legal guardian understand and agree that, unless I have expressly notified the KPSC of any physical handicaps, they may assume the registrant to be in good physical condition and able to participate in activities without limitations.

I am responsible for providing transportation to and from all games and practices.
I will accept responsibility for abiding by all of the rules and regulations of the KPSC, including but not limited to:

KINGS PARK SOCCER CLUB - PLAYER / PARENT CODE OF CONDUCT

Player’s Code:

1. Play for the fun of it, not just to please your parents or coach.
2. Play by the Laws of the Game.
3. Never argue with or complain about referees’ calls or decisions.
4. Control your temper. Most of all, resist the temptation to retaliate when you feel you have been wronged.
5. Concentrate on playing soccer with your best efforts. Work equally hard for your team as for yourself.
6. Be a good sport by cheering all good plays, whether it’s your team or your opponent’s.
7. Treat all players, as you would like to be treated.
8. Remember that the goals of the game are to have fun, improve your skills and feel good. Don’t be a showoff or a ball hog.
9. Cooperate with your coaches, teammates, opponents and the referees.
10. Come prepared to play. Wear your complete uniform to games. Always bring a ball to practice.

Parent’s Role:

1. Provide safe and prompt transportation for your child to and from team and club related events, especially practice sessions and games.
2. Pay attention when watching your child play. There will be a test in the car on the way home!
3. Stay positive—Cheer!! Don’t yell. Never criticize.
4. Support each player on the team, not just your child—he/she can’t do it alone!
5. Don’t be a sideline coach or referee. Let the coach do the coaching!
6. Set a good example and never yell at the referee.
7. Ensure child brings equipment to and from all soccer games and practices when appropriate.
8. Call the coach when your child misses or is going to miss a game or practice. Find out when the next game or practice is. Don’t make the coach track you down.
9. Volunteer! Being involved in your child’s soccer team and organization is fun and you’ll make many wonderful friends!!
10. ALLOW YOUR CHILD TO BE A CHILD!

Reminder To All

The KPSC has instituted the following policies to insure a safe and healthy environment for all of our players and spectators:
1. No Smoking or use of alcohol or drugs on or around any of our playing fields while attending games and practices.
2. No Pets allowed at any of our playing fields while attending games and practices.
3. No Parking along St. Johnland Road or areas inside Tiffany Field designated as “no parking”.
4. No Parking along the Fire Lane at William T Rogers Middle School.

The KPSC runs on "VOLUNTEER POWER".
Please indicate your preferred area of participation below.

Parent or Guardian #1	Parent or Guardian #2

Promotion Code:

The KPSC reserves the right to bring sanctions against any members and their guests found to be in violation of the Code of Conduct.
By Registering you acknowledge that all information contained herein is correct and that you have read and understand the KPSC Code of Conduct.

By Registering, you agree, warrant and covenant as follows:

The Kings Park Soccer Club ("KPSC") will not be held liable for injuries sustained on the playing field. Soccer is a Dangerous sport and injuries can and do happen.

1. Authority to Register and/or to Act as Agent. You represent and warrant to KPSC, that you have full legal authority to complete this registration, including full authority to make use of the credit or debit card to which registration fees will be charged. In addition, if you are registering third parties, you represent and warrant that you have been duly authorized to act as agent on behalf of such parties in performing this registration. By proceeding with this Registration, you agree that the terms of this Registration Agreement shall apply equally to you and to any third parties for whom you are acting as agent.

2. Compliance with Children's Online Privacy Protection Act (COPPA). You represent and warrant that, in compliance with COPPA, you are over thirteen (13) years of age, and that if you are registering a child under fourteen (14) years of age you are the parent of such child, and do hereby consent to the collection of such child's personal information by the KPSC.

3. Limitation of Liability; Disclaimer of Warranties. KPSC SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES, RESULTING FROM (A) THE USE OR THE INABILITY TO USE KPSC SITE OR (B) FOR THE COST OF PROCUREMENT OF SUBSTITUTE GOODS AND SERVICES OR (C) RESULTING FROM ANY GOODS OR SERVICES PURCHASED OR OBTAINED OR TRANSACTIONS ENTERED INTO THROUGH KPSC OR (D) RESULTING FROM UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA, INCLUDING BUT NOT LIMITED TO, DAMAGES FOR LOSS OF PROFITS, USE, DATA OR OTHER INTANGIBLE, EVEN IF KPSC HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. YOU EXPRESSLY AGREE THAT USE OF KPSC SITE IS AT YOUR SOLE RISK. KPSC SITE IS PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS. KPSC EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE OR NON-INFRINGEMENT. KPSC makes no warranty that the KPSC sites' services will be uninterrupted, secure or error free. KPSC does not guarantee the accuracy or completeness of any information in, or provided in connection with, the KPSC sites. KPSC is not responsible for any errors or omissions, or for the results obtained from the use of such information. You understand and agree that any material and/or data downloaded or otherwise obtained through the use of the KPSC sites is at your own discretion and risk and that you will be solely responsible for any damage to your own computer system or loss of data that results from the download of such material and/or data.

4. Indemnification. You agree to indemnify and hold each of KPSC and its officers and employees harmless from any claim or demand, including reasonable attorneys' fees, made by any third party due to or arising out of your use of KPSC or the violation of any term of this Liability Waiver or the KPSC Terms of Service by you.

5. Applicable Law; Consent to Jurisdiction. The KPSC sites (excluding linked sites) are controlled by KPSC from its offices within the State of New York, United States of America. By completing this registration, you agree that exclusive jurisdiction for any dispute with KPSC resides in the courts of the State of New York, County of Suffolk and you further agree and expressly consent to the exercise of personal jurisdiction in the courts of the State of New York, County of Suffolk in connection with any dispute including any claim involving KPSC or its affiliates, subsidiaries, employees, contractors, officers, directors, telecommunication providers and content providers.

6. Severability. If any provision of this Liability Waiver shall be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Liability Waiver and shall not affect the validity and enforceability of any remaining provisions.

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