Registration is due by July 24, 2016

CYO 2016 FALL Soccer 201622222Registration

Registration is due by July 24, 2016

Soccer is Co-ed for grade 1st-8th

Date: _____________________

Player Information (Please Print):

Child’s Name:
Grade:
Gender (Circle One):	Male / Female
Birth Date:
If not a student at St. Vincent, which parish do you attend CCD?

Parent/Guardian Information (Please Print):

Parent/Guardian Name:
Home Address:
City, State, Zip:
Contact Phone Numbers: (home/cell/work)
E-Mail Address:
Emergency Contact:
Any Player Health Conditions/Allergies:

Parental Consent:

I agree to hold harmless and defend Saint Vincent Parish, the Archdiocese of Mobile, or representatives associated with the above mentioned activity from any and all liability claims, loss or damage arising from or in connection with my child’s/children’s participation in this activity. I understand that I shall be liable and agree to pay all cost and expenses in connection with such emergency medical and dental service rendered to the child pursuant to this authorization. I also authorize an adult in whose care the minor has been entrusted to consent to any emergency treatment to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. Should it be necessary for my child to return home due to medical reasons or otherwise, I, shall assume all transportation costs. I also give permission for my child to ride in any vehicle designated by the adult in whose case the minor has been entrusted while attending and participating in activities sponsored by Saint Vincent Church.

Health Insurance Company:
Policy Number:
Group Number:
Signature (Parent/Guardian):
Date:

CYO & Booster Club Fees:

CYO Fee = $55.00 per child

Booster Club Fee = $20.00 per family

Uniform:

Soccer Shirt = $15.00 per shirt

Please Circle Size: Youth Small Youth Medium Youth Large

Adult Small Adult Medium Adult Large

ÿ Yes, I already have a uniform shirt from last year. Number______________

Parent/guardian is responsible for purchasing soccer shorts and soccer socks. The soccer shorts and soccer socks shall be all black, and can be purchased at Wal-Mart, Target, Academy, or other sporting good providers.

ALL FEES & SHIRT COST ARE DUE WITH SUBMISSION OF THIS REGISTRATION FORM!

** Make Checks payable to SVS Booster Club **

Please mail registration form and fees to:

SVS Booster Club

6625 Three Notch Rd

Mobile, AL 36619