Reuter Family YMCA Youth Soccer League

Fall 2011 Registration Form

Registration:
League Information:
st
th
Dates: July 1 - August 26
Passers: Ages 3-4
Registration Fee: $70 Member; $90 Non- Member
Kickers: Ages 5-7
*Financial Assistance Available*
League Dates:
First Week of Practice: September 5th
Season: September 27th- November 5th
Practices at Averys Creek Elementary/Games Saturdays at Carolina Day School
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Reuter Family YMCA Soccer Registration Form

Return this form with payment to Reuter Family YMCA Member Services by August 26th

_____________________________________________________________________________________________________________________
Players Name
Birth Date
Age & Division (Passers or Kickers)
Sex
_____________________________________________________________________________________________________________________
Childs School
Number of seasons played soccer
_____________________________________________________________________________________________________________________
Mailing Address
City
State
Zip
_____________________________________________________________________________________________________________________
Parent Contact
Phone
E-mail (Required)
Please list one car pool buddy: ______________________________________
Volunteers Needed! Please circle one
Head Coach
Assistant Coach
Referee

Please Circle Preference for Practice

Monday
Thursday

ANY

Tuesday
Wednesday

Jersey Size
Youth
XS S M L

Adult
S M L

I hereby, for myself, my heirs, executors, and administrators, waive and release any and all claims and damages I may have against the
YMCA of Western North Carolina and their respective agents, representatives, successor, and assigns, for any and all injuries which may
be suffered by me or my family. I agree to comply with YMCA policies and procedures and understand that my participation can be
terminated without refund for exhibiting inappropriate behavior or abuse toward the YMCA staff and/or facilities.

Please list any medical conditions:

Signature

Todays Date