Stokes Valley Junior Soccer Club
2010 Player Registration Form
(Please complete a separate form for each player registering. This information will only be used by the Stokes Valley
Football Club and NZ Football for statistical and administration purposes.)
Player’s Surname: First Name:
Date of Birth: / /
Parents/Guardians Contact Details:
Phone: Home: Work:
E-Mail (if you want to receive club info):
Did your child play for Stokes Valley Junior Soccer in 2009? YES / NO
If yes, what team?
Does your child have any medical conditions we should be aware of? YES / NO
If yes, please provide brief details below.
ASSISTANCE WITH THE JUNIOR CLUB (please tick) YES NO
Can you assist with fundraising and/or providing sponsorship?
Can you assist with coaching / managing a team (training available)?
Can you help on the Junior Club committee?
(For Junior Committee use only)
Subscription Type: Individual: $60 per Individual Player
Family: $90 for 2 or more players from the same Family
Amount Paid $