2014 Middle School Soccer Program

2014 Middle School Soccer Program

For 7th & 8th grade students
Dates: Practices will begin on April 14th , 2013
Site: Current middle school
Games: Game schedules will be handed out by the coach.
Cost for entry into ALL middle school contests:
Adults: $3.00
Students $1.00
Eligibility: All 7th and 8th Grade students.
Cost: $10.00 per student
Required: All participants must have a current school year pre-participation physical on file with your middle school nurse’s office. Please turn your physical into the middle school nurse’s office. The Des Moines Public Schools Soccer Program will not be responsible for misdirected or misplaced physical forms.
Transportation: Athletes will practice at their current middle school. Transportation will be provided to and from games.
Registration Information: To register, please detach the registration panel of this flyer and complete the form. Return the registration form, participation fee and medical information form (signed by your middle school nurse) to the coach on the first day or earlier if possible.
Please take the middle panel to the school nurse for signature and then return the middle panel to the soccer coach. This must be completed before you practice or play. /

MEDICAL INFORMATION

Middle School Soccer

Nurse must sign. Participants must return to soccer coach.
Des Moines Independent Community School District Student Emergency Information. Please print clearly. Please make sure that a person, not an answering machine, will answer phone numbers.
Participant’s Name______
Middle School Attending______
Parent’s Name______
Address______
City/State______
Day Phone______Evening Phone______
Emergency Contact Information:
Name______
Address______
City/State______
Day Phone______Evening Phone______
Hospital Information:
Name______
Phone______
Doctor Information:
Name______
Phone______
I hereby approve of my child’s participation in this athletic program and certify that my child is in good health and able to participate in the program activities. Also, I certify that my child is adequately insured against injuries. I authorize the staff to act for me according to their best judgement in any emergency requiring medical attention.
Parent Signature______Date______

To be completed by School Nurse

The below signature of School Nurse certifies that above named student has a current year physical on file at middle school.
Physical Date______
Nurse Signature______Date______ / Registration Form for Middle School Soccer
Participant’s Name______
Middle School Attending______
Birth Date______Age______Grade______
Parent’s Name______
Address______
City/State______Zip______
Day Phone______
Evening Phone______
I hereby approve of my child’s participation in this athletic program and certify that my child is in good health and able to participate in the program activities. Also, I certify that my child is adequately insured against injuries. I authorize the staff to act for me according to their best judgement in any emergency requiring medical attention.
Parent’s Signature______Date______
Amount Enclosed $______(10.00 per person)
Please make checks payable to Des Moines Public Schools.
Payment Method: Cash___ Check___ Money Order___
Check or Money Order #______
DETACH AND SEND THIS FORM & FEE WITH YOUR CHILD ON OR BEFORE THE FIRST DAY OF PRACTICE AND TURN INTO COACH.
NO REFUNDS AFTER THE SECOND WEEK OF THE SEASON!

For Office Use Only

(To be completed by the school representative receiving this form.)
Received by______Date______
Upon full payment of fees, a photocopy of this form will be provided to you if requested.
REGISTRATION PANEL INSTRUCTIONS
The registration panel of this form contains information that is required by the Middle School to register a participant for this activity. Payment must accompany this form and must be sent with your child on the first day of practice.
IT IS EXTREMELY IMPORTANT THAT THIS PANEL BE COMPLETED AND RETURNED WITH PROPER PAYMENT TO YOUR CHILD’S MIDDLE SCHOOL COACH ON THE FIRST DAY OF PRACTICE.
Please take the middle panel to the school nurse for signature and then return both the middle panel and the registration form to the middle school coach on the first day of practice. This must be completed before you practice or play.
Middle School Soccer Contact Information
Student Activities Specialist
Allyson Vukovich

242-8376
Student Activities Specialist
Jason Allen

242-8377 / MIDDLE PANEL INSTRUCTIONS
The middle panel of this form contains information that the coach may need in the event of a participant’s incident which may require contact of a parent.
It is extremely important that the middle panel be signed by the middle school nurse and returned to the soccer coach with the registration. This middle panel must be completed before you may practice or play.
The soccer coach will retain this record for use throughout the season. / INFORMATION PANEL INSTRUCTIONS
The information panel of the form contains information that the parent may need to be informed of this activity.
It is extremely important that the parent retain this panel since it contains information about this activity.
Registration Form, Registration Fee, and Medical Information Panel should be turned in the coach on or before the first day of practice.