STREATOR YOUTH SOCCER
2015 FALL REGISTRATION FORM
SIGN UP FEE: $45.00 REGISTRATION DEADLINE: 6/28/2015
LATE FEE TO REGISTER AFTER DEADLINE = $25!(Total Fee = $70)
Receipt #______Mail To: Streator Youth Soccer
Cash ______PO Box 198
Streator, IL 61364
PLEASE PRINT
Player Name: ______Boy____ Girl ____ Fall 2015 Grade: ______
Player’s Birthdate:______E-mail Address:______
Address: ______
City: ______PRIMARY PHONE # ______
Shirt Size (Please check the box that applies.)
Youth Sizes:______Small ______Medium ______Large
Adult Sizes:______Small ______Medium ______Large ______Extra Large
Please list any medical issues coaches should be made aware of:
______
Primary Emergency Contact: ______Phone: ______
Secondary Emergency Contact: ______Phone: ______
SYS WILL ONLY ENSURE THAT SIBLINGS IN THE SAME LEAGUE WILL BE ON THE SAME TEAM AND THEREFORE PRACTICE AT THE SAME TIME. ALL OTHER SIBLING PRACTICES WILL BE DETERMINED BY THE DRAFT. NO EXCEPTIONS.
Sibling name in same league (if applicable): ______
ADDITIONAL FALL SPORT POLICY – Coaches need to be aware of conflicting sports that your child may also play in the fall (baseball, softball, football, etc.) Please list other sports your child will participate in that may conflict with their attendance of soccer practices and games:
I give my child permission to participate in Streator Youth Soccer, including traveling to out-of-town games if necessary. I also release any liability toward the YMCA or Streator Youth Soccer. I understand that teams are limited to the amount of volunteer coaches for that age group. I also understand that I may be responsible to participate in fundraising efforts as deemed by Streator Youth Soccer.
Signature of Parent or Guardian:______Date:______
Please remember that the success of Streator Youth Soccer comes from the support of the parents. If you are interested in any of the following positions below please contact us at
____Head Coach____Assistant Coach____Concession Stand Board Member Referee Grounds & Fields