Athletic Registration Form
Fall Co-ed Soccer (ages 6-14)
Girls Basketball (grades 2-8)
Co-ed Basketball (K-1 grades)
Boys Basketball (grades 2-6)
Spring Co-ed Soccer (6-18)
Co-ed Volleyball (grades 2-8)
Spring/Fall Micro Soccer (ages 4-5)
Player's Name:
Parent's Name:
Contact Email Address:
Birthdate:
(month/day/yr; eg.:01/02/03)
Age:
Grade:
Phone:
Address:
City:
School:
Child lives with (names please!):
Does child have a sibling participating in this league?
yes
no
If yes, name of sibling:
D.O.B.
(month/day/yr; eg.:01/02/03)
Grade:
Shirt Size: Please Circle One:
Youth Sizes:
Youth Small
Youth Medium
Youth Large
Adult Sizes:
Adult Small
Adult Medium
Adult Large
Adult X-Large
**If you select the wrong size for your child, you will be responsibile for purchasing a new one!
Interested in Coaching?
--Please fill in your information below. Thank you for volunteering!
Name:
Relationship to the Player:
Home Phone:
Work Phone:
**All coaches will be required to submit to a criminal history background check
I am interested in:
(please check all that apply)
Head Coach:
Assistant Coach:
For your convenience we accept MasterCard, Discover and Visa Cards. Membership fee:$23 B-ball Fee:$27
Questions? Call 765-362-8912
Date:
(month/day/yr; eg.:01/02/03)