Registration Form
Baltimore International Soccer Academy presents the 4v4 BISA Cup Tournament Entry Form Saturday, August 1, 2015 Herring Run Park Entry Fee Maximum of 6 co-ed players per team. Three game guarantee. Early Registration Fee per team is $160. Registration deadline is June 18, 2015. Regular Registration Fee per team is $180. Registration deadline is July 18, 2015. Entry form and roster must be sent with fee by deadline. Please make checks and money orders payable to: Baltimore International Soccer Academy General Information Games will be played on grass fields at Herring Run Park. Duration of games is two 10 minute halves. Tournament rules and game schedule will be emailed once your team is completely registered. All schedules and rules will be posted on www.baltimoreintsocceracademy.com/4v4tournament.html. 50% refund will be given if team withdraws on/before July 18th. No refunds after July 18th. For further information, please call 443-983-8228 or e-mail baltimoreintsocceracademy@gmail.com. Divisions January February March April May June July August September October November December 2011 U6 U6 U6 U6 U6 U6 U6 U6 U6 U6 U6 U6 2010 U6 U6 U6 U6 U6 U6 U6 U6 U6 U6 U6 U6 2009 U6 U6 U6 U6 U6 U6 U6 U8 U8 U8 U8 U8 2008 U8 U8 U8 U8 U8 U8 U8 U8 U8 U8 U8 U8 2007 U8 U8 U8 U8 U8 U8 U8 U8 U8 U8 U8 U8 2006 U10 U10 U10 U10 U10 U10 U10 U10 U10 U10 U10 U10 2005 U10 U10 U10 U10 U10 U10 U10 U10 U10 U10 U10 U10 2004 U12 U12 U12 U12 U12 U12 U12 U10 U10 U10 U10 U10 2003 U12 U12 U12 U12 U12 U12 U12 U12 U12 U12 U12 U12 2002 U14 U14 U14 U14 U14 U14 U14 U12 U12 U12 U12 U12 2001 U14 U14 U14 U14 U14 U14 U14 U14 U14 U14 U14 U14 2000 U14 U14 U14 U14 U14 Mail completed forms to: Baltimore International Soccer Academy 4313 Kolb Avenue Baltimore, Maryland 21206 Baltimore International Soccer Academy 4v4 BISA Cup Tournament Entry Form Payment and completed roster form must be sent together. Soccer Club Name _________________________________________ Team Name _________________________ Address _________________________________________ City _____________ State ________ Zip __________ Team Manager __________________________________________ Cell # _______________________________ Email Address __________________________________________ Age Bracket [ ] U6 [ ] U8 [ ] U10 [ ] U12 [ ] U14 Please Print Clearly Player 1 (Captain) Player 2 Name _________________________________________ Name _________________________________________ __Male __Female __Male __Female Age _____ DOB ___/___/___ Age _____ DOB ___/___/___ Signature _____________________________________ Signature _____________________________________ Signature of Parent/Guardian Signature of Parent/Guardian By signing, you have read and agreed to the Waiver of Liability & Rules, as well as the Medical Release. Player 3 By signing, you have read and agreed to the Waiver of Liability & Rules, as well as the Medical Release. Player 4 Name _________________________________________ Name _________________________________________ __Male __Female __Male __Female Age _____ DOB ___/___/___ Age _____ DOB ___/___/___ Signature _____________________________________ Signature _____________________________________ Signature of Parent/Guardian Signature of Parent/Guardian By signing, you have read and agreed to the Waiver of Liability & Rules, as well as the Medical Release. Player 5 By signing, you have read and agreed to the Waiver of Liability & Rules, as well as the Medical Release. Player 6 Name _________________________________________ Name _________________________________________ __Male __Female __Male __Female Age _____ DOB ___/___/___ Age _____ DOB ___/___/___ Signature _____________________________________ Signature _____________________________________ Signature of Parent/Guardian Signature of Parent/Guardian By signing, you have read and agreed to the Waiver of Liability & Rules, as well as the Medical Release. By signing, you have read and agreed to the Waiver of Liability & Rules, as well as the Medical Release. Signature of Coach/Manager: __________________________________________________________________ By signing, you have read & agreed to the “Waiver of Liability & Rules
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