YOUTH SOCCER by liuqingyan


									                       SOCCER PARTICIPATION RELEASE FORM

        I/We do hereby waive any and all liabilities that the City of Hampton, VA,
                                                                                                                                                   YOUTH SOCCER
   and/or the Phillips Athletic Association, Inc., their agents or representatives may
   incur as a result of any injury or other misfortune which may befall me/us and/or                                                            PAA FALL SOCCER REGISTRATION at Syms Middle School
   my/our child/ward while engaged in the above named programs sponsored by                                                                            Saturday, June 25, 2011, 10:00 a.m. - noon
   the Hampton Recreation Division of Parks and the Recreation Department
   and/or the Phillips Athletic Association, Inc.                                                                                                        Monday, July 11, 5:00 p.m. – 6:30 p.m.
        I/We declare that I/we understand the risk involved in the above named                                                                           Or register by mail to: PAA
   program due to the nature of the sport.                                                                                                                                       6 Hunter Trace
        If I/we are not present, I/we agree to let the Hampton Parks and Recreation
                                                                                                                                                                                 Hampton, VA 23669
   Department or coaches with the Phillips Athletic Association, Inc. care for my/our
   child/ward in the event of an emergency. I/We declare that to the best of my/our                                                              Completed forms and fees must be received by July 11, 2011.
   knowledge and belief, my/our child/ward is in good health and physical condition                                                            Registration Information
   to participate in the above named program.                                                                                                                                      League Information
                                                                                                                                               The on-time registration fee is $40.00 per player.
                                                                                                                                               Registration will be held on the above dates/times      PAA has teams for all children between the ages of
   Signature of Parent/Guardian_____________________________________ Date:_______________                                                      at Syms Middle School or you may register early         4 through 18. Players on these teams typically
                                                                                                                                               by mailing or hand-delivering the completed form        have a two to three-year age span with the
                                                                                                                                               to PAA, 6 Hunter Trace, Hampton, VA 23669.              exception of the oldest age group which has a
                       BE SURE TO SIGN ABOVE OR REGISTRATION FORM                                                                                                                                      larger age span. The player’s birth year is used to
                                                                                                                                               Checks will not be cashed before June 25, 2011.
                                 WILL NOT BE PROCESSED!                                                                                                                                                determine in which league he will play.
                                                                                                                                               A separate registration form must be filled out for
     I, ________________________________ (name), will help in the areas marked:                                                                each participant. One check may be written for          Coaches will contact their team by mid-August and
                                                                                                                                               multiple registrations received by (not                 begin practice shortly thereafter. Games will begin
     ( ) Coach                                ( ) Team Parent                             ( ) Field Maintenance                                postmarked by) July 11, 2011. Forms are                 in September. Coaches determine the days and
                                                                                                                                               available at the Willow Oaks Library or thru the        times for practice. Practices and games are held at
     ( ) Assistant Coach                      ( ) Phone Calls                             ( ) Help Initially Mark Fields
                                                                                                                                               web site of                         places such as Gosnold's Hope Park, the Hampton
     ( ) Data Entry                           ( ) Help at Registration                    ( ) Hang Soccer Nets                                                                                         Soccer Complex or area schools.
                                                                                                                                               Late Registration - The late registration               In order to balance the teams, requests for a
PLAYER FEE: $40.00 by 7/11/11, $50.00 after 7/11/11. Make checks payable to PAA. Forms received after                                          fee is $50.00 per player. Registrations received
7/11/11 will be placed on a waiting list. Mail forms to PAA, 6 Hunter Trace, Hampton, VA 23669.                                                                                                        specific team or coach or requests to carpool
                                                                                                                                               after July 11, 2011 will be considered late. Late       with a coach or a multiple number of players
                                                                                                                                               registrants should complete a registration form and     will be ignored. Requests for carpooling with a
                                             COACHES FORM                                                                                      mail or hand-deliver with a separate $50.00 check       (only one) specific player will be considered only
     Complete if you will coach a team – one coach’s shirt provided. Additional coach’s shirts                                                 for each participant. Include a self-addressed          if both players are in the same age bracket and
     can be ordered for $10. Payment is due before the shirt order goes in- please specify size)                                               stamped envelope so the check(s) can be returned        parity of teams can be maintained. Both
                                                                 Phone (H): ________________                                                   if no openings become available by the second           carpooling players must specify the name of the
                                                                                                                                               week of the season. Unfilled slots and vacated          other person on their registration form, and both
     Name: ____________________________________________ Phone (W): ________________                                                            slots will be filled by late registrants in the order   players will be entered into the draft. Siblings
                                                                                          Phone (C): ________________                          registrations are received. In other words, those       in the same age group will be placed on the
                                                                                                                                               who get their forms and payment in will be              same team and considered a carpool, but you
     E-Mail Address: _________________________________________________________________                                                         placed in front of those who call to be put on the      must provide the names of the siblings in the
                                                                                                                                               waiting list.                                           comments section of the registration form so it
     Age range you would like to coach:                  ______________________________________________                                                                                                will not be overlooked.
                         or                                                                                                                    Cancellation Policy - Cancellations must                Players, except those in the youngest two age
     Name and birth date of related player: ______________________________________________                                                     be received in writing at the above address before      groups, are re-divided every season to balance
                                                                                                                                               the end of the season for which you registered.         the teams.
     Name of PAA team you last coached: ________________________________________________                                                       You must include the player’s name, birth year, a
                                                                                                                                               self-addressed stamped envelope, and name that
                                                                                                                                               will be on the refund check. Cancellations              Bottom line – requests may
     Circle the days of the week you plan on practicing:                       Mon          Tue          Wed          Thu          Fri
                                                                                                                                               received by July 11 will receive a full refund.
                                                                                                                                               After this date, a pro-rated refund not to exceed
                                                                                                                                                                                                       not be honored.
     Time you plan to begin practice: ______________ Location of practice: _____________________                                               $30 will be given if the shirt, socks, etc. are             Complete Registration Forms Accurately!
                                                                                                                                               returned and a replacement player is found. All              Incorrect information can result in your
     Shirt Size (Circle):         Adult Medium            Adult Large           Adult X-Large            Other: _____________                  vacant slots in the league will be filled before              child being placed on the waiting list!
                                                                                                                                               replacements are made.
                                                                                                                                                                                                     Check Number ________
Board Meetings                                       EARN MONEY
    The Phillips Athletic Association Board meets    BE A SOCCER OFFICIAL!                                                          SOCCER REGISTRATION FORM
on the last Monday of selected months at 7:30 p.m.
in the meeting room at the Willow Oaks Library.          Interested in being a soccer official? You                                                           (Please Print Legibly)
Volunteers are needed to serve on the Board.         must be at least 13 years old by August 1, 2011
                                                                                                                   Player's Name: ________________________________________________                         Circle Male Female
Several positions are open. Call 851-6600.           and USSF certified. Certification classes for
Come to the meeting - get involved!                  soccer officials are offered periodically by the
                                                                                                                   Name Player is called (if different than first name above): ___________________________________
                                                     Peninsula Soccer Officials Association.
                                                     Information on training sites and times will be
                                                     posted under “Cert/Recert” at                                 Name of Parent/Guardian: ________________________________________________________
Registration Dates                          For
                                                                                                                   Relationship to Player: ______________________________________________________________
                                                     additional information on becoming certified or
SPRING SOCCER - First two Saturdays after            officiating for PAA, contact Mike Foley at
New Year's Day                                       851-5166.                                                     Phone Number: _______________________                       Alternate Phone Number: ________________
BASEBALL - Late March to early April
                                                                                                                   Street Address: ____________________________________________________________________
FALL SOCCER – Late June to early July
FUTSAL – November (if we can find a gym to                                                                         City: _________________________________________ State:                 VA       Zip Code: ________________
support the program)
                                                                                                                   E-Mail Address: ________________________________________________________(PAA use only)
Registration forms are available at the Willow
Oaks Library usually two weeks or more before                                                                                                                  (Please Print Legibly)
      Mark your calendar…It's up to you!                                                                             Circle Year of Birth:     07 06 05 04 03 02 01 00 99 98 97 96 95 94 93 92
                                                                                                                                    Must be 4 by Dec 31, 2011 and cannot be 19 years old before Sep 1, 2011

  Bring Used Items                                                                                                   Circle Month of Birth:     Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
  To Registration                                                                                                           Compared to other players your child's age, how would you rate your child?
  If you have shoes, shin guards, or black           Phillips Athletic Association Soccer is a recreational          Circle Skill Level:     1      •      2      •      3    •      4       •      5
  shorts, sweat pants, or warm-up pants that         league. Its goal is to enable our youth to have fun while                                Least Skilled                                                    Very Skilled

  you can no longer use, please bring them to        developing positive values of cooperation, teamwork
                                                     and self-esteem in a safe and structured environment.           Circle T-shirt Size:     YOUTH:           S    M   L           ADULT:     S     M     L   XL       XXL
  registration on Jun 25 or Jul 11, 2011. We
                                                     PAA Soccer is open to female and male youth between             Circle Sock Size:        Junior                Youth           Regular          (Sizes may vary)
  will line them up and let everyone "shop" for      the ages of 4 and 18. It is directed and staffed solely by
  a better size.                                     unpaid community volunteers. PAA is always seeking
                                                     volunteers for all aspects of the program. Some areas
                                                                                                                     If player participated in the 2011 PAA Spring Soccer and was born in 2004 or later:
                                                     of particular need are:
                                                                                                                     Would you like the same team? _____ … Or would you like to enter the draft?______
        PAA PROGRAMS?                                COACHES - Usually need coaches at all age levels. If you've
                                                     been an assistant, please consider coaching.

           CALL THE PAA                              HELP AT REGISTRATION – Review registrations and
                                                     assist as needed                                                Comments:_________________________________________________________________
              851-6600                               DATA ENTRY - Key in registration information in Excel and
                                                     transfer file over the Internet.
                                                     FIELD MAINTENANCE - Help spread dirt on fields.                 Birth years 1992 - 1997, COMPLETE THIS SECTION:
         visit the PAA Website at
                                                     PHONE CALLS - Make 10 to 20 calls on an occasional basis.                                                                                              Do you play goalie?      Circle          YES       NO
                                                     MAINTAIN LINES – Paint the lines on fields at a given
                                                     location such as Jones throughout the season.                   Do you play:        Select soccer ______               JV soccer ______        Varsity soccer ______
  If you need to leave a message for any
  of the PAA programs, call 851-6600.                HANG SOCCER NETS – Hang and take down nets as needed

  Please speak slowly. Along with your                If you can help, note this on the registration form.
  message, leave your name, player’s
  name, date of birth, phone number and                                                                                                                             (over)
  e-mail address. You will be called back at
  a later date.                                                                                                           you must sign the back of form

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