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Freeport Area Soccer Association

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5

Dec, 2017

In House Registrations

     

Spring 2018 Developmental Soccer Registration           Travel  Registration online only due Jan. 15th

                                             

Player Name______________________________Address/city/zip___________________________________________________________

 

Player Birth date_____/_____/_____         Age________             Male________ Female________

 

Mother Name ______________________Phone #_________________  e-mail address ___________________________________

 

Father Name _______________________Phone #_________________  e-mail address ___________________________________

_________________________________________________________________________________________________________________ 

DEVELOPMENTAL                   BIRTH DATE FALLS BETWEEN                                            REGISTRATION FEE      

______Under 5                          January 1, 2013 and  December 31, 2013                           $45.00 + fundraiser

______Under 6                          January 1, 2012 and  December 31, 2012                           $45.00 + fundraiser

______Under 7                          January 1, 2011 and  December 31, 2011                           $55.00 + fundraiser

______Under 8                         January 1, 2010 and  December 31, 2010                           $55.00 + fundraiser

______Under 9 (Saturday)        January 1, 2009 and  December 31, 2009                           $65.00 + fundraiser

______Under 10 (Saturday)      January 1, 2008 and  December 31, 2008                           $65.00 + fundraiser

 

               Under 9 and Under 10  Sunday Travel Teams, registration is online after Dec. 3rd

 

CARPOOLING REQUESTS (U5-U6-U7-U8 ONLY)     NO COACH REQUESTS ACCEPTED.  ______________________________

 

Circle SHIRT SIZE if required      Youth Sm           Youth Md            Youth Large             Adult Sm        Adult Med          Adult Lg

Note: One blue shirt and one gold shirt will be issued to each player per school year

PAYMENT      Please postmark by 02/15/2018

Make Check Payable and mail to:                                                                                                                 Registration Fee       $_______   

Freeport Area Soccer Association      

P.O. Box 13                                                                Three or more children registered -  $7 each      -$_______

Sarver, PA 16055          

                                                                                       Add $25.00 late fee if submitted after June 15, 2017     $_______

 

                                                                                                               TOTAL PAYMENT                             $_______               

               

U-9-U-10 inhouse -  ONLY NO REGISTRATIONS ACCEPTED AFTER Feb 15, 2018 unless needed to fill a team.            

 

   Legal Authorization for Emergency Care and Acknowledgment of Disclaimer

Does your child have any medical problems that you wish to bring to the attention of his/her coach?_______ Please detail on back

To induce the Freeport Area Soccer Association to accept registration and to permit participation in FASA by the below named individual, I/We, the parent(s) or guardian(s) of said individual, hereby give my/our consent and agree to release, indemnify, and hold harmless FASA,

Its officials, coaches, and representatives, from any claims arising out of injuries or conditions caused by or aggravated by my/our refusal to available medical treatment based on religious or philosophical beliefs.  I/We, the undersigned parent(s) or guardian(s) of the participant, a minor, do hereby authorize the coaches, assistant coaches, or parents of team members acting in the capacity of activity supervisor’s vehicle drivers as agents for the undersigned to consent to medical, surgical, or dental examination and/or treatment.  By signing below I hereby, consent to/and permit photographs of myself and/or that of any minor children to be used by FASA for purposes including educational and advertisement, and in any medium including print and electronic.

 

Please initial if you DO NOT want any photographs taken of yourself and/or any minor children by FASA, ____________.

 

In case of emergency, I/We authorize treatment and/or care of     (player name)   _______________________________

If there is and emergency and I/We cannot be reached, please contact _________________________Phone_____________________ who is authorized to act in my/our behalf.

                __________________________________________________________                         Date ____/_____/_______

                                                Parent or Guardian Signature (required)                                                                        

FASA is a volunteer organization and we are always in need of help.  If you are interested in coaching, assistant coaching, field maintenance, fundraising, or assisting our program in any way please X here  ____________

This correspondence is being circulated as a community service at the request of a non-school organization.  The information and/or activities are not associated with the Freeport Area School District.  Any questions or correspondence should be directed to Linda Hafer at 724-316-8924.

                   Go to    www.freeportsoccer.com    for club information and updates
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