2009/2010 INDOOR SOCCER SEASON
Player’s Name: Male Female
Date of Birth: (mm/dd/yy) Were you a registered player last year Y N
Home Phone No: Cell Phone No:
Email (That gets checked most frequently)_________________________________________________________
Use back if necessary
Emergency Contact: (other than Parent or Guardian): Name:
Rovers League: Cheques made payable to: Valley Soccer Association
U-12 1998/99 $ 325 U-16 1994/95 $ 325
U-14 1996/97 $ 325 U-18 1991/92/93 $ 375
Please note that Premiere and Division 2 team fees will have additional charges of $100 per player due to playing on
a larger field.
Also, if there is no coach available as a volunteer in the winter, a additional fee may be charged in order to hire
Jersey Deposit - $50.00 MUST BE A SEPARATE CHEQUE FROM REGISTRATION FEE.
POST DATE TO March 1, 2009
Where are you able to help: Coach Assit. Coach Team Helper Executive
As a parent of a player I understand that solely volunteers operate the Soccer program and that I will be required to
help with team operations and/or Association fundraising.
I will allow the above registered player to participate in the sport of minor soccer with VSA and/or the Town
Association. I will hold harmless Valley Soccer Association and the Town Association for any liability arising out
of the participation in the 2009/10 Winter Program.
Registrations will not be accepted after August 31/09.
OFFICE USE ONLY
METHOD OF PAYMENT: CASH CHEQUE NO AMOUNT REC’D: RECEIPT #
JERSEY DEPOSIT REC’D: CASH CHEQUE NO. AGE LEVEL:
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