Spring 2018 Developmental Soccer Registration ** Travel Registration online beginning December 1st
Player Name______Address/city/zip______
Player Birth date_____/_____/_____ Age______Male______Female______
Mother Name ______Phone #______e-mail address ______
Father Name ______Phone #______e-mail address ______
______
DEVELOPMENTAL BIRTH DATE FALLS BETWEEN REGISTRATION FEE
______4 year olds January 1, 2013 and December 31,2013 $45.00 + fundraiser
______5 year olds January 1, 2012 and December 31,2012 $45.00 + fundraiser
______6 year olds January 1, 2011 and December 31,2011 $55.00 + fundraiser
______7 year olds January 1, 2010 and December 31, 2010 $55.00 + fundraiser
______8 year olds (Saturday) January 1, 2009 and December 31, 2009 $65.00 + fundraiser
______9 year olds (Saturday) January 1, 2008 and December 31, 2008 $65.00 + fundraiser
9 and 10 year old Sunday Travel Teams, registration is online beginning December 1st
CARPOOLING REQUESTS (4-5-6-7-8 yr old ONLY) NO COACH REQUESTS ACCEPTED. ______
Circle SHIRT SIZE if required Youth Sm Youth Md Youth Large Adult Sm Adult Med Adult Lg
Note: One blue shirt and one gold shirt will be issued to each player per school year
PAYMENT Please postmark by 02/15/2018
Registration Fee $______
Make Check Payable and mail to: Three or more children registered – discount - $7 each -$______
Freeport Area Soccer Association
P.O. Box 13 Fundraiser Candy max two per family $30.00 $______
Sarver, PA 16055 (Box of candy that can be sold to recover this expense)
OR
Candy buyout max two per family $20.00 $______
Add $25.00 late fee if submitted after February 15, 2018 $______
TOTAL PAYMENT $______
9 and 10 yr old in-house - NO REGISTRATIONS ACCEPTED AFTER March 1, 2018 unless needed to fill a team.
Legal Authorization for Emergency Care and Acknowledgment of Disclaimer
Does your child have any medical problems that you wish to bring to the attention of his/her coach?______Please detail on back
To induce the Freeport Area Soccer Association to accept registration and to permit participation in FASA by the below named individual, I/We, the parent(s) or guardian(s) of said individual, hereby give my/our consent and agree to release, indemnify, and hold harmless FASA,
Its officials, coaches, and representatives, from any claims arising out of injuries or conditions caused by or aggravated by my/our refusal to available medical treatment based on religious or philosophical beliefs. I/We, the undersigned parent(s) or guardian(s) of the participant, a minor, do hereby authorize the coaches, assistant coaches, or parents of team members acting in the capacity of activity supervisor’s vehicle drivers as agents for the undersigned to consent to medical, surgical, or dental examination and/or treatment. By signing below I hereby, consent to/and permit photographs of myself and/or that of any minor children to be used by FASA for purposes including educational and advertisement, and in any medium including print and electronic.
Please initial if you DO NOT want any photographs taken of yourself and/or any minor children by FASA, ______.
In case of emergency, I/We authorize treatment and/or care of (player name) ______
If there is and emergency and I/We cannot be reached, please contact ______Phone______who is authorized to act in my/our behalf.
______Date ____/_____/______
Parent or Guardian Signature (required)
FASA is a volunteer organization and we are always in need of help. If you are interested in volunteering, place an X next to the following: Coaching______Assistant Coaching ______Clean Up Day______
Weekend Concession Stand ______Fundraising______Picture Day______Clothing Sale______