St. Henry Youth Soccer Registration Form â 2017 *SOCCER IS ...
St. Henry Youth Soccer Registration Form – 2017 *SOCCER IS MOVING TO NORTH PARK* All Registration Forms must be returned to St. Henry Schools by May 17, 2017 with payment stapled to this form. If you have more than 1 child playing, only list 1 child per form and staple all forms with payment together. Soccer will be played north of the North Park parking lot. Practice will start in August 2017 and the season concludes with a Soccer Party in early October. No games will be played on Fridays. Games will be played in the evenings during the week and on Saturday mornings (with no conflict with flag football), with one weekend where games are to be played on a Sunday afternoon (Soccer Sunday).
Player’s Last Name: _______________________ First Name:____________________ Age:____ Street Address:___________________________ City:___________ State:_______ Zip Code:_____________ Birth Date:_____________ Gender: _______________Grade in School (Fall 2017):_____________________ Siblings in soccer and grade: _____ Health problems: Parents Name:_________________________________________________________ Home Ph.:_______________
Cell:____________
Shirt Size: YL (14-16 Youth) AS (Adult SM) AM (Adult MED) AL (Adult LG) XL (Adult XL) Note: Shirts should be ordered large so that warm clothes (sweatshirt) can be worn underneath.
Coaches: The St. Henry Youth Soccer Program is an all-volunteer league that is dependent on parents volunteering to coach. Please indicate below if you would be willing to help coach your child’s team. Coach; Name: _________________________
_
Referees: The St. Henry Youth program also needs volunteers for referees. Please indicate below if a member of your household would be willing to referee. ($1 per game bonus for returning refs from 2016) Referee; Name:_____________________________________ (Pay $7.00 per game. Must be 7th grade or older) * shirt size: _________Please list fall activities (volleyball, football, etc.)____________________________________
Player Participation Fees (Includes: Team Shirt and Matching Socks) $25.00 per child No Applications will be accepted after 05/17/17 I, the parent or guardian have read "A Parent's Guide to Concussion in Sports" which can be found under Concussion Information under the Coaches tab at www.shyouthsoccer.com. I, the parent or guardian of the minor registrant, recognizes the possibility of physical injury associated with soccer and in consideration of the “St. Henry Soccer Program” release all responsibilities of the Coaches, Referees, volunteers, and the St. Henry Soccer Program from injuries that my child could receive playing soccer. Signature of Parent or Guardian ______________________________________________
If you have any questions, please feel free to contact a board member. Ted Heitbrink (419) 852-3878, Greg Schwartz (419) 852-3740, Maureen Kramer (419) 842-8012, Bill Gast (419) 852-1517, Nikki Lange (419) 305-2964, Scott Laguire (419) 733-9796, Tony Schwieterman (419) 953-8785, Matt Zimmerman (419) 852-6320
Player’s Last Name: _______________________ First Name:____________________ Age:____ Street Address:___________________________ City:___________ State:_______ Zip Code:_____________ Birth Date:_____________ Gender: _______________Grade in School (Fall 2017):_____________________ Siblings in soccer and grade: _____ Health problems: Parents Name:_________________________________________________________ Home Ph.:_______________
Cell:____________
Shirt Size: YL (14-16 Youth) AS (Adult SM) AM (Adult MED) AL (Adult LG) XL (Adult XL) Note: Shirts should be ordered large so that warm clothes (sweatshirt) can be worn underneath.
Coaches: The St. Henry Youth Soccer Program is an all-volunteer league that is dependent on parents volunteering to coach. Please indicate below if you would be willing to help coach your child’s team. Coach; Name: _________________________
_
Referees: The St. Henry Youth program also needs volunteers for referees. Please indicate below if a member of your household would be willing to referee. ($1 per game bonus for returning refs from 2016) Referee; Name:_____________________________________ (Pay $7.00 per game. Must be 7th grade or older) * shirt size: _________Please list fall activities (volleyball, football, etc.)____________________________________
Player Participation Fees (Includes: Team Shirt and Matching Socks) $25.00 per child No Applications will be accepted after 05/17/17 I, the parent or guardian have read "A Parent's Guide to Concussion in Sports" which can be found under Concussion Information under the Coaches tab at www.shyouthsoccer.com. I, the parent or guardian of the minor registrant, recognizes the possibility of physical injury associated with soccer and in consideration of the “St. Henry Soccer Program” release all responsibilities of the Coaches, Referees, volunteers, and the St. Henry Soccer Program from injuries that my child could receive playing soccer. Signature of Parent or Guardian ______________________________________________
If you have any questions, please feel free to contact a board member. Ted Heitbrink (419) 852-3878, Greg Schwartz (419) 852-3740, Maureen Kramer (419) 842-8012, Bill Gast (419) 852-1517, Nikki Lange (419) 305-2964, Scott Laguire (419) 733-9796, Tony Schwieterman (419) 953-8785, Matt Zimmerman (419) 852-6320
