U14, U16 & U19 LEAGUES
U14, U16 & U19 LEAGUES 2017 NIS INDIVIDUAL REGISTRATION FORM Player Information Name:
Sex:
Girl
Address:
Age:
(as of December 31, 2017)
Boy
Birth Date: Parents Name Name:
Name:
Phone:
Phone:
E-mail:
E-mail:
Shirt Size (adult ) Skill Level: Playing Experience:
Small High Traveling
Check The League That Applies U14, U16 & U19 Leagues U19 ($93.00) U16 ($93.00) U14 ($93.00)
Medium Medium Non-Traveling
Large
XL Low None
XXL
If You Are Not On A Team, Player Request (Not guaranteed, has to be player not on a team) Player Name: . If You Are On A Team Team Name: . Team Coach: . Team Manager:.
Please make your checks payable to “NIS” Amount enclosed Cash Check no.
OFFICE USE ONLY Date Received:
Registrations received after February 5, 2017 will be considered late and the following apply: LATE FEE of $10.00 will be charged (PLEASE INCLUDE WITH PAYMENTS) – NO EXCEPTIONS Special requests will not be considered For each RETURNED CHECK a fee of $30.00 will be charged Volunteers Needed Coach/Assistant Name: Email:
Team Caller Phone No:
INDOOR SOCCER RELEASE In consideration of your accepting this registration, I hereby for myself, heirs, executors and administrators, waive and release any and all rights and claims for damages I or my child may have against the Anoka Area Ice Arena, North Indoor Soccer, their representatives, successors, assignors any and all persons associated with the 2017 indoor season for any and all injuries suffered by me or my child while participating or spectating at or in the indoor soccer program.
Parent or Guardian:
. print name
signature
RETURN TO STEVE NASH, 14500 BOWERS DR NW, ANOKA, MN 55303
Sex:
Girl
Address:
Age:
(as of December 31, 2017)
Boy
Birth Date: Parents Name Name:
Name:
Phone:
Phone:
E-mail:
E-mail:
Shirt Size (adult ) Skill Level: Playing Experience:
Small High Traveling
Check The League That Applies U14, U16 & U19 Leagues U19 ($93.00) U16 ($93.00) U14 ($93.00)
Medium Medium Non-Traveling
Large
XL Low None
XXL
If You Are Not On A Team, Player Request (Not guaranteed, has to be player not on a team) Player Name: . If You Are On A Team Team Name: . Team Coach: . Team Manager:.
Please make your checks payable to “NIS” Amount enclosed Cash Check no.
OFFICE USE ONLY Date Received:
Registrations received after February 5, 2017 will be considered late and the following apply: LATE FEE of $10.00 will be charged (PLEASE INCLUDE WITH PAYMENTS) – NO EXCEPTIONS Special requests will not be considered For each RETURNED CHECK a fee of $30.00 will be charged Volunteers Needed Coach/Assistant Name: Email:
Team Caller Phone No:
INDOOR SOCCER RELEASE In consideration of your accepting this registration, I hereby for myself, heirs, executors and administrators, waive and release any and all rights and claims for damages I or my child may have against the Anoka Area Ice Arena, North Indoor Soccer, their representatives, successors, assignors any and all persons associated with the 2017 indoor season for any and all injuries suffered by me or my child while participating or spectating at or in the indoor soccer program.
Parent or Guardian:
. print name
signature
RETURN TO STEVE NASH, 14500 BOWERS DR NW, ANOKA, MN 55303
