Alumni Game

Date: April 14, 2012 Rain Date: April 15, 2012
Time: Ladies 11:00 / Men's 1:00 Time: Ladies 1:00 / Men's 3:00
Location: NHHS Stadium
Registration fee: $25.00 (includes t-shirt)
Friends and Family: $5.00 gate fee (adults)
NHHS students with ID: $3.00

You are invited to participate in our "NHHS Alumni Soccer Games!"
This is your opportunity to support the boys and girls who are following in your footsteps. Invite your friends and family to join the fun.

Event contact:
Jo Ellen Young 678-997-8867 cell or (joellen.young@hallco.org)

To submit registration & payment to:
Jo Ellen Young, Soccer Booster Club VP
NHHS
ATTN: ALUMNI SOCCER
4885 Mt. Vernon Road
Gainesville, GA 30506

Select forms and print. Complete both Registration and Medical Form and mail with registration fee. Notary will be on-site for your Medical Form verification.

NHHS Alumni Soccer Date: April 14, 2012

Information Section

Priority Registration will be honored on a first come, first serve basis. Registration deadline is March 19, 2012.

Name: ___________________ Alumni Year: __________________

Physical Address:______________________________________________

_____________________________________________________________

E-Mail Address: _______________________________________________

Current school or occupation: ___________________________________

T-Shirt Size (specify S, M, L, XL): ________

Preferences accepted only through March 10^st: Designate 1^st, 2^nd, 3^rd:

_____ Number (list # ______)

_____ Color (circle one: green/white)

_____ Number and color (list # ______ /color ________)

List medical concerns or issues we should be aware of for your safety: (Medical Release must be signed before play time.)

_______________________________________________________________________________________________________________________________________________________________________________________

Signature: ___________________________________________________

Please make check payable to:

North Hall Soccer Booster Club

(Can drop off at NHHS or mail)

** see invitation for details**

MEDICAL RELEASE FORM

I,_____________________________ (Player/Parent/Guardian's Name)

hereby give permission for any and all medical attention to be administered to my player/myself ____________________________(Player Name).

In the event of accident, injury, sickness, etc., under the direction of the person(s) listed below, until such time as I may be contacted. I also assume the responsibility for the payment of any such treatment. This release is effective for the period of one year from the date given below.

ADDRESS: ______________________________________________________________________

______________________________________________________________________

HOME PHONE: ______________________________________________________________________

INSURANCE COMP: ____________________________________________________________________

POLICY NUMBER: _____________________________________________________________________

In case it is necessary, any of the following persons is designated to act on my behalf.

* Alumni Event Director: _______________________________________________________________

* NHHS Booster Club Officer: ___________________________________________________________

* EVENT MANAGER: ___________________________________________________________________

* A school representative where event is being held/game is playing.

* Any event representative onsite where participating in Alumni event.

PHYSICIAN: ______________________________________________________________________

ADDRESS: ______________________________________________________________________

PHONE: ______________________________________________________________________

KNOWN ALLERGIES: ______________________________________________________________________

SIGNATURE (PLAYER/PARENT/GAURDIAN)

______________________________________

DATE __________________

Subscribed and sworn before me,

this ______ day of __________________ , 20 _____

________________________________________________

Notary Public