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MYSA Fall2012 Registration with Cash, Check or Money Order

! Indicates required information

If returning, last years coach name;:
 ! Player First Name(as listed on Birth Certificate):
Middle Initial:
 ! Player Last Name:
 ! Parents Names:
 ! Street Address:
 ! City:
 ! State:
 ! Zip Code:
 ! Home Phone:
Work/Cell Phone:
Email Address:
Male or Female:
Player Birth Date:
Uniform Size:
Co-Ed or Girls:
Players Age:
PLEASE FILL OUT FORM COMPLETLY AND THEN CLICK SUBMIT. YOU WILL NEED TO SEND A CHECK FOR THE APPROPRIATE AMOUNT TO,
MYSA
PO Box 3632
Monroe, NC 28111-3632
FEE SCHEDULE
MICRO - $50 Includes uniform for new players.
U7-U14 $60($80 for new or requiring a new uniform) if registered and paid in full by September 1st. $80 returning and $100 new after this date. All fees must be paid by March 17th.
PLEASE LIST YOUR CHILD'S NAME ON YOUR CHECK AND INCLUDE CHECK NUMBER ON THIS FORM.
 ! Check # and Date Mailed:
I the undersigned parent or legal guardian of the above named child. Do hereby certify to the best of my knowledge that he/she is physically able to take part in the soccer program. I also agree to hold harmless the City of Monroe, its employees, instructors and volunteers and MYSA. I agree to assume all risks and hazards incidental to the conduct of the program activity. Including transportation to and from the activity. I also agree to maintain a sportsman like behavior both on and off the fields as will the above named child during all activities.
As Parent or legal Guardian I agree to the above.
 ! Parent Or Guardian:
I would be able to help with:
Please list any additional comments here

! Indicates required information


       




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