Join NEPSL - Online Registration Form

image Please fill out our online registration form. If you are registering more than one child, then you MUST fill out separate registration forms per child. Of course, only one payment submission is required. We will contact you via email or phone number confirming your registration.

Registration fees are as follows:
NOTE:  $0.75 PayPal transaction fee has been added

REGISTRATION FEES
1 Child: $60.75
(non-refundable)
2 Children: $115.75
(non-refundable)
3 Children: $170.75
(non-refundable)

After submitting this registration form, you will be able to choose which option you are interested in listed above.

Any questions please don't hesitate to contact us, CLICK HERE .

Items in RED are mandatory. Please enter N/A if a mandatory item is not applicable. Your registration will be denied and monies refunded if any of the RED mandatory items are not filled out.

Player's Last Name:
Player's First Name:
Player's Middle Initial:
Player's Nickname:
Gender:
Male
Female
Date Of Birth:
Years Played:
Home Phone Number:
Address:
City:
State:
Zip Code:
E-mail Address:
Confirm E-mail Address:
Father's Name:
Father's Contact Number:
Mother's Name:
Mother's Contact Number:
Emergency Contact's Name:
Emergency Contact's Number:
Any siblings playing with us?
YES
NO
If yes, sibling's names:
Would you or your spouse coach a team?
YES
NO
Would you or your spouse be a team mom/dad?
YES
NO
Would you or your spouse be a league volunteer or helper?
YES
NO
Would you or your business or someone you know sponsor a team?
YES
NO
Jersey/Shirt Size?

Child Small (6-8)
Child Medium (10-12)
Child Large (14-16)
Name of Insured:
Insurance Provider:
Group/Policy Number:
Physician:
Physician's Phone Number:
Known Allergies:
Will you being paying your fees online or sending in payment?
Online
Sending In Payment

Any special requirements or other things we might need to know:

By checking here and submitting this form, you have read, understand, and agree to the Code of Ethics.

You also hereby give permission for any and all medical attention to be administered to your child(ren) in the even of accident, injury, sickness, etc., under the direction of the person(s) listed above, until such time as you may be contacted. You also assume the responsibility for the payment of any such treatments and hold NEPSL's staff not liable for any monies charged. This is effective for the period of one year from the date this form is submitted. In the case that you cannot be reached, you give NEPSL's staff, representative, tournament representative, and/or coaches permission to act on your behalf.

 
Please only click the "Submit Form" button once.
It could take up to 2 minutes to submit.
 
 





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