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registration_form_2012_spring

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					                                   QUINCY YOUTH SOCCER
                       SPRING 2012 IN-HOUSE SOCCER REGISTRATION
Circle One:
       RETURNING QYS PLAYER                                                      FEES
                                                                  (checks payable to Quincy Youth Soccer):
       PLAYER NEW TO QYS*                                                      U6: $50
       *must have Birth Certificate
       Birth Certificate ___________                                 Returning Players From
                                                                     Fall 2011 U7-U15: $50
Circle One:           MALE                  FEMALE
                                                                     New/Not Registered in
AGE GROUP              Check One                                     Fall 2011 U7-U15: $75
U6 – born in 2006______                                             TOPSoccer for athletes with
U7 – born 08.01.04 – 12.31.05________                                 disabilities ~ No Fee
U8 – born 08.01.03 – 07.31.04________
                                                                           FEES ARE
U10 – born 08.01.01 – 07.31.03_______                                  NON -REFUNDABLE
U12 Co-ed: born 08.01.99 – 07.31.01_______
U15 Co-ed: born 08.01.96 – 07.31.99_______
    All players must play in appropriate age group. No Exceptions.
I WOULD LIKE TO ASSIST QUINCY YOUTH SOCCER IN THE FOLLOWING CAPACITY:
      VOLUNTEERS ARE ALWAYS NEEDED. SUPPORT YOUR SOCCER LEAGUE.
                  ___COACH                            ____ASSISTANT COACH
                 ____COMMISSIONER                  _____BOARD OF DIRECTORS

NAME:__________________________________________PHONE:______________


PLEASE WRITE LEGIBLY (Player Information)
First Name __________________________ Last Name ___________________________
Address _______________________________________Zip Code ___________________

Quincy Youth Soccer Information is sent via email. Please include your email address.
Email ___________________________________________________________________
Player’s Date of Birth _____________________Phone____________________________
School Attending:__________________Uniform Size: YS YM YL YXL AS AM AL AXL
                                                   (circle one)
WAIVER:     I HEREBY ABSOLVE QUINCY YOUTH SOCCER, ALL COACHES, ASSISTANT COACHES, OFFICERS, REFEREES, AND
OTHER PARTICIPANTS IN QYS ACTIVITIES FROM ALL LIABILITIES, AND WILL NOT HOLD THEM RESPONSIBLE FOR
INJURIES TO THE ABOVE NAMED PERSON. I HEREBY GIVE MY APPROVAL FOR HIS/HER PARTICIPATION IN QUINCY YOUTH
SOCCER.

PARENT SIGNATURE:__________________________________________PHONE:_________________________________


               QUINCY YOUTH SOCCER ~ PO BOX 692209 ~ QUINCY, MA 02269
                                   617-472-9033

				
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