PCSSA Registration Fall/Winter 2019 - 2020

* Required Fields
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Fee: $120.00Must be paid by Sept 1, 2019 to be eligible to participate in the 2019/2020 season
*Player Participation Agreement
 PCSSA Participation Agreement • I understand that my registration to play in the PCSSA is not valid and will not be accepted if I do not check this participation requirement block. By checking this block, I fully agree to the following requirements:  Pay my membership dues on time. Full membership dues must be received by PCSSA Treasurer by the due date specified in this registration form  Fully support the PCSSA at all times  Fully support my team manager when asked to do so (practice, field prep, monthly field maintenance, brooming/raking the field when visitors, and etc)  Keep my manager informed as to dates I will not be available to play  Arrive at least 30 minutes prior to my scheduled game time  Inform the Board of Directors (Director of Player Personnel) as to my availability for the yearly draft.  Include date available for participation for the upcoming year  Include any issues that will have an impact on my ability to compete at my rated skill level • Failure to fully comply with these requirements, as determined by my team manager, will result in the following:  For my first referral (verbal or written) by my team manager, I acknowledge that I will be placed on notice by the PCSSA Board for violation of this agreement  For a second referral by my team manager, I acknowledge that I will be suspended from the league for two consecutive games  And I further acknowledged that for a third referral, I will be suspended for the remainder of the current season from the date suspension is ordered by the Board • No refund of membership dues will be authorized by the Board of Directors 
Please Read
 Use proper format as indicated in sample. Use proper capitalization in names (first letter capitalize in first and last name only). Click "Pay In Person" when done. If form does not disappear, check for completeness of required fields. Non-Playing managers must check the appropriate box in both the Primary and Secondary position selection. 
*Residency Requirement
 I understand that PCSSA By-Laws require that I am a Pebble Creek resident for at least 90 days. (If you are unable to commit to this requirement, please cancel this registration). 
Participant
*First Name
*Last Name
*Email
*Phone Number (XXX-XXX-XXXX)
*Primary Position
*Secondary Position
Sub List
 Sub List Only (Check this box if you do not want to be drafted or assigned to a Team) 
*BirthDate (MM/DD/YYYY)
mm/dd/yyyy
*Shirt Size
Preferred Number -1st - 2nd - 3rd XX-XX-XX
Don't type in this field
*Days Available to Play
*Emergency Contact
*Emergency Contact Phone Number (XXX-XXX-XXXX)
Enter 10/19/2019 below if you will be available to play at the start of the season.  If you will not be available to play at the start of the season, enter the date that you will be available. 
*Date Available for your First Game (MM/DD/YYYY)
mm/dd/yyyy
*Waiver, Release of Liability and Indemnification
 By checking this box, I agree to the League Rules, and Waiver, Release of Liability and Indemnification (under league documents from home page). 
*Enter Your First Year In The PCSSA (YYYY)
Number of Active Years in the PCSSA
*Pebble Creek Address:
*Unit-Lot:
*Own or Rent
If Renting - Rental Start Date
mm/dd/yyyy
Rental End Date
mm/dd/yyyy
*Remit dues by:
 Remit dues by 9/1/2019 to be eligible for the draft 
Please submit payment to:
Tom Bose
16342 W Sheila Ln
Goodyear, Az 85395
Total Due:
$ 
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