ACADEMY SELECT REGISTRATION FORM
River Valley Futbol Club (RVFC)
ACADEMY SELECT REGISTRATION FORM PLEASE PRINT AND FILL OUT COMPLETELY AND BRING TO ORIENTATION WITH $25.00 PLAYER DEPOSIT
Season 2017-2018 (June 1, 2017-May 31, 2018
PLAYER INFORMATION Players last name: Are you a Returning Player? Yes
First:
Middle:
If returning, last team playing with:
School Currently Attending:
Birth date:
Age:
Gender:
No
M
F
Address: Mother’s Name:
Primary phone no.:
Alternate phone no.:
Father’s Name:
Email:
T-Shirt Size:
Birth Year 2008 ($25 deposit + $175 for the year OR $25 deposit+ $25 a month July-January, payment options below) Birth Year 2009 ($25 deposit + $175 for the season OR $25 deposit + $25 a month July-January, payment options below)
Choose Age Group of Birth Year:
PAYMENT INFORMATION Please fill out completely. Payment in Full to RVFC (Cash/Check/CC) Yes
No
Payment Monthly (Cash/Checks/CC) Yes
If Paying By Visa/MasterCard Enter Card # here:
No
Card Expiration Date: Card CVV #: Monthly CC Charged on the 10th.
Check/Cash Payments must be made by the 10th of each month at: 3017 S 70th St Suite A, Fort Smith, AR 72903
Banner/Work To Play:
Yes
Please note, if Banner/WTP, the player will not be rostered until payment/work is completed.
5% CC Processing Fee added to each payment if opting to pay with credit card.
Cardholder Name:
Card Billing address:
Card Zip Code:
No
IN CASE OF EMERGENCY Name of Emergency Contact:
Relationship to player:
Home phone no.:
Cell phone no.:
If choosing monthly credit card payments, I authorize River Valley Futbol Club (RVFC) to charge my card each month on the 10th of the month. I also acknowledge monthly payments by credit card will incur a 5% processing fee. I understand that I am financially responsible for any balance owed in full for the year if my player makes a team roster. Player must be current to play in games.
Parent/Guardian signature
Date
ACADEMY SELECT REGISTRATION FORM PLEASE PRINT AND FILL OUT COMPLETELY AND BRING TO ORIENTATION WITH $25.00 PLAYER DEPOSIT
Season 2017-2018 (June 1, 2017-May 31, 2018
PLAYER INFORMATION Players last name: Are you a Returning Player? Yes
First:
Middle:
If returning, last team playing with:
School Currently Attending:
Birth date:
Age:
Gender:
No
M
F
Address: Mother’s Name:
Primary phone no.:
Alternate phone no.:
Father’s Name:
Email:
T-Shirt Size:
Birth Year 2008 ($25 deposit + $175 for the year OR $25 deposit+ $25 a month July-January, payment options below) Birth Year 2009 ($25 deposit + $175 for the season OR $25 deposit + $25 a month July-January, payment options below)
Choose Age Group of Birth Year:
PAYMENT INFORMATION Please fill out completely. Payment in Full to RVFC (Cash/Check/CC) Yes
No
Payment Monthly (Cash/Checks/CC) Yes
If Paying By Visa/MasterCard Enter Card # here:
No
Card Expiration Date: Card CVV #: Monthly CC Charged on the 10th.
Check/Cash Payments must be made by the 10th of each month at: 3017 S 70th St Suite A, Fort Smith, AR 72903
Banner/Work To Play:
Yes
Please note, if Banner/WTP, the player will not be rostered until payment/work is completed.
5% CC Processing Fee added to each payment if opting to pay with credit card.
Cardholder Name:
Card Billing address:
Card Zip Code:
No
IN CASE OF EMERGENCY Name of Emergency Contact:
Relationship to player:
Home phone no.:
Cell phone no.:
If choosing monthly credit card payments, I authorize River Valley Futbol Club (RVFC) to charge my card each month on the 10th of the month. I also acknowledge monthly payments by credit card will incur a 5% processing fee. I understand that I am financially responsible for any balance owed in full for the year if my player makes a team roster. Player must be current to play in games.
Parent/Guardian signature
Date
