St. Cecilia Sports Program
2010 Fall Soccer Registration Form
· U-6 soccer is open for players born between AUG 1, 2004 –
JUL 31, 2006
-Requests for exceptions will be considered at the discretion of the St. Cecilia Sports Committee
· Player Development Session will be held on SUN AUG 29
from 1:30-2:30 in an effort to provide basic skills training through various stations and provide instruction to
volunteer parent-coaches; event
confirmation will be sent to registered players approximately two weeks prior· First game is expected to be SUN SEPT 12 with the season scheduled to end on OCT 24
· This outdoor soccer league is an instructional league and utilizes 3 vs 3 · Games
are played on SUN afternoons @ St. Cecilia (2:00 and 3:00); Practices are offered ½ hr prior to each game
Registrations can be mailed-in
postmarked by AUG 14th orQUESTIONS?
-- Contact Darrin McCaffrey at 363-1617 or via email at DMcCaffrey@magniindustries.com
PLAYER INFORMATION | Last Name:
First Name:
BOY / GIRL Birth
Date: / /
(circle one)
|
| Street Address:
City:
Zip:
Phone: |
| Prior Coach or Team
Color
Shirt Size(circle one):
Youth Xtra Small Youth Small Youth
Medium Every attempt will be made to honor shirt sizes with on-time registrations; else will likely receive
Youth Sm.
Player School:
|
| Preferences/Notes/Allergies/Medical Conditions: |
Please note: St. Cecilia Sports Committee (SCSM) will attempt to honor coach and teammate requests as practical.
However, the U-6 Soccer Coordinator will make every attempt to create balanced teams in the best interest of all players,
primarily based on player evaluations conducted during the player development sessions. Should you
feel your child may be ready to move up a division, we request you speak with your previous coach and/or a member of the SCSM.
SCSM, along with input from the coaches and parent will consider requests to move players up a division based on the
best interest of the child and roster availability.
PARENT/GUARDIAN
CONTACT INFORMATION | Name:
Email address:
Phone:
|
| Name:
Email address:
Phone: |
VOLUNTEER INFORMATION (Please
circle activity in which you are interested) | Coach
Asst. Coach
Field
Lining
Administration |
| Please Circle the Name of the Parent/Guardian Listed Above Offering to Volunteer
Virtus Certified?: Y / N |
INDEMNIFICATION & LIABILITY WAIVER | I, the parent/guardian of the above named Player, a minor, agree that I and the player will
abide by the Rules and regulations of the soccer league, the affiliated organizations, and it’s sponsors. In consideration
of the player’s participation in the soccer programs and activities of the soccer league parties I, for myself and the
player and our respective heirs, administrators and successors, intending to be legally bound, hereby release and indemnify
the soccer league parties, the owners and operators, employees, agents and representatives from against all claims, liabilities,
damages or causes of action arising out of or in connection with the players participation in the programs. I also understand
that this is a recreational soccer league and unsportsmanlike conduct will not be tolerated from the players or parents. Coaches
will have the right to dismiss a player from the team for offensive behavior demonstrated by that player, their parent, or
Guardian, while at practice or a game. In signing the below, I testify that I am a Legal Guardian of the
above-named Player.LEGAL GUARDIAN SIGNATURE |
| NAME:
Signature:
Date: |
FEES (please
check all that are applicable) U-6
$30 per Player or
Family Rate ALREADY Paid $150 (includes older age brackets) Late Fee - $10 per player (if post-marked after AUG 14th (please contact me prior) On-site registration ($40 per player) will be accepted on SUN MAR 21h
(weather permitting) 1:00-1:30 at St. Cecilia Soccer FieldsHardship circumstances, please contact Darrin McCaffrey at 859.363.1617 |
Please mail completed form along with check - made payable to “St. Cecilia Sports
Program”- to: Darrin McCaffrey 4972 Open Meadow Drive Independence
KY 41051 |
Soccer Registration will be June 22nd . 2010 6:30-8:00PM.
Please mail form postmarked no later than July 23rd. Mail to: Darrin McCaffrey 4972 Open Meadow Dr., Independence,KY 41051.
| Last Name:
First Name:
Phone: |
| Street Address:
City:
St: Zip:
|
| Birth Date: /
/ Sex:
Prior Coach:
email: Player School:
Last
5 Digits SSN#: |
Yes, I am interested in helping in the following areas: (circle)
Coach
Asst. Coach
Referee
Field Lining Administration
Email:
Phone:
Yes, I am interested in helping in the following areas: (circle)
Coach
Asst. Coach
Referee
Field Lining Administration Email:
Phone: |
Please
note: All new players will be randomly
assigned to a team, per league rules. It is a privilege, not a right to move up a division.
Circle One U8
U10 U12
U14
U16
August 1,2002
August 1,2000
August 1,1998 August
1,1996
August 1,1994
July 30, 2004
July 31,2002
July 31,2000
July 31,1998
July 31,1996
U8-U16- $75 per player
-Check if new player: $30 new uniform PREPAID (if needed).
Family rate-$150 (includes U6)Late fee-$10 per player
(After: Tuesday th).
Hardship cases: (Contact:Darrin McCaffrey (895)363-1617.
I, The parent/guardian of the above named player, a minor, agree that I and the player will abide by the
Rules
and regulations of the soccer league, the affliated organizations, and it’s sponsors. In consideration
of the player’s participation in the soccer programs and activities of the soccer league parties I, for myself
and the player and
our respective heirs, administrators and successors, intending to be legally bound, hereby
release and indemnify the soccer league parties, the owners and operators, employees, agents and representatives
from
against all claims, liabilities, damages or causes of action arising out of or in connection with the players
participation
in the programs. I also understand that this is a recreational soccer league and unsportsmanlike
conduct will not be tolerated from the players or parents.
Coaches will have the right to dismiss a player from the
team for offensive behavior at practice or a game.
Make Checks Payable to:St. Cecilia Sports Program
Mother’s Name:
Father’s Name:
Sports Program Use Only----do not write below this line---Date:
Time:
Birth Certificate:
Amount paid:
Chk#: