MCCC INDOOR SOCCER Facility APPLICATION
2011-2012

 

TEAM NAME   _____________________________________________________________________________

 

COACH   ____________________________________________HOME #  (_____)_______________________

                                                                                                   BUSINESS (_____)_______________________

ADDRESS    ________________________________________________________________________________

                                                                                                                       

CITY _______________________STATE________ZIP ___________ EMAIL  ____________________________

 

SECOND CONTACT  ________________________________HOME #    (_____)_______________________

                                                                                          BUSINESS #   (_____)_______________________

ADDRESS _________________________________________________________________________________

 

CITY  _______________________STATE________ZIP ___________ EMAIL ____________________________

 

Current Soccer League and Placement: _________________________________________________________

If a strong and weak division is formed, in which would you like your team? ญญญ__________________________

Fall 2010 Record: (if available) _______________    2010/2011 MCCC Indoor Record__________________

 

Age of oldest player as of July 31, 2011(Circle):

Boys_____________ Girls ____________ U18, U17, U16, U15, U14, U13, U12, U11, U10, U9 U8

*Must play in same age group as Fall 2011 season or higher

 

Indicate guest players with * (max 3)                                        Indicate secondary                                                                                                                  carded players with**

TEAM ROSTER

 

Player Name                                     Birthday           Player Name                                    Birthday

1.___________________________________________       10. __________________________________________

2.___________________________________________       11. __________________________________________

3.___________________________________________       12. __________________________________________

4.___________________________________________       13. __________________________________________

5.___________________________________________       14. __________________________________________

6.___________________________________________       15. __________________________________________

7.___________________________________________       16. __________________________________________

8.___________________________________________       17. __________________________________________

9.___________________________________________       18. __________________________________________

 

Please make checks for $450 (which includes certified official fees) payable to: Mercer County Community College.

Application must be received by noon on October 21, 2011.

 

Mail to:                 John Simone, Director                                                      FOR OFFICE USE:

                                Athletics & Student Activities                                         Payment Date:                                    #                             

                                Mercer County Community College                             Roster Verif. Date:                             by:                         

P.O. Box B, Trenton, NJ 08690-1099                           Player Passes Date:                           by:                         

                                                                                                Comments: