ATTENTION ALL SOCCER PLAYERS

It’s time again to register for soccer!

Registration will be held Saturday April 10th from 11:00am to 1:00pm at the Grand Bay-Westfield Centrum (in the Grand Bay Room, use the Woolastook Road door).

COST*: 4-7 yrs. - $50.00, 8-9 yrs. $70.00 and 10-15 yrs. - $90.00.

**$20.00 late fee if registering after 15 May, 2010.

*U4 yrs. old can register(at parents discretion).

**If two or more (family) are registered, there is a $5.00 discount per additional child 2^nd, 3^rd, etc.

***Please have child’s NB Medicare number!!

Parent coaches are always needed, Without your help we can’t do it, if you plan on being there, please get involved!!

For information please contact David Peterson @ 650-2284.

email:rv.soccer@gmail.com

PS. If you have any uniforms lying around, this would be a good time to return them.

REGISTRATION FORM 2010

Player Personal Information

Name:

Birthdate:     /    /     Age (As Of Jan. 1st):    Sex:

D M Y

Parents: And

Address City: PCode:

Phone (H) : (W) : (C) :

Email:

Emerg’y Contact: Phone (Day) : (Eve) :

Family Doctor: Phone: Provincial Medicare #:

RELEVANT MEDICATIONS

MEDICAL ALLERGIES

HISTORY PREVIOUS INJURIES

DOES THE PLAYER CARRY AND KNOW HOW TO ADMINISTER HIS OR HER OWN MEDICATIONS? YES NO

OTHER CONDITIONS:

NOTE: ONLY AUTHORIZED INDIVIDUALS WILL HAVE ACCESS TO THIS INFORMATION.

Volunteer (volunteers are always needed, coaching training will be provided when available)

COACHING: REFEREES: ADMINISTRATION:

Fees: Summer Program

Under 6 : Birth Year 2004 and 2005 (4 – 5 years old) - $50.00

Monday 6:30-7:30 or Wednesday 6:30-7:30

Under 8 : Birth Year 2002 and 2003 (6 – 7 years old) - $50.00

Monday 6:30-7:30 or Wednesday 6:30-7:30

Under 10: Birth Year 2000 and 2001 (8 – 9 years old) - $70.00

Under 12: Birth Year 1998 and 1999 (10–11 years old) - $90.00

Under 14: Birth Year 1996 and 1997 (12–13 years old) - $90.00

Under 16: Birth Year 1994 and 1995 (14–15 years old) - $90.00

(discount, after 1st child) X $5.00 =

Total:

Cheque #: Received by:

Spring School League: (Grades 4&5) School: