Edwardsville Rookies Soccer Registration Form

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EDWARDSVILLE YMCA ROOKIES FALL 2008 SOCCER PROGRAM Fees: Members $35; Nonmembers $45 Registration Deadline: Monday, August 11, 2008 Program Begins: Saturday, September 13, 2008 Registration fee includes a t-shirt. Fees must be paid at the time of registration. Please call the YMCA at 656-0436 if you have any questions.
Players' name:
Birth Date:		Age:
Address:		City:
State:		Zip:
Phone:		Sex: M - F
School Attending this year:		Grade:
Parent Name:		Email:
YMCA Member? Y - N	Shirt Size (circle one):	Youth: M - L	Adult: S - M - L - XL
Has player participated in YMCA Soccer League? Y - N		Which team?
Will parent(s) help coach one of our soccer teams? Y - N (see explaination of coaching responsibilities in cover letter)
If you marked yes, please write parent(s) name below: Name(s):		Email:
Are you a member of any select/club soccer team this season? Y - N
Parent Agreement: I agree to my child's participation in the YMCA soccer program, and that s/he will comply with all league rules and regulations. I further agree that I will not hold the YMCA, the league, its sponsors, or field owners responsible in case of accident or injury. I fully understand that no accident insurance is provided and that I am responsible for such coverage if so desired. Parent/Guardian Signature:_______________________________ Date:_____________
Date Received by YMCA ___________ Membership Expires ____________ Receipt Number __________ Amount Paid __________ Staff Initials ______