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Valley Youth United Youth Soccer Inc.
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Last updated
09-17-13 11:31 AM
Get Directions to Valley Youth United Youth Soccer Inc.Peckville Local Weather
Valley Youth United Youth Soccer Inc.
Alan Gillow
5706502814
Fax: 5704892455
503 Keystone Ave
Peckville, Pennsylvania
18452
 
  Welcome  
 

Monday, May 28

2012 Registration we will be adding an additional day please check back here for date and times

 

 

 

M  /  F

 

 

First Name

MI

Last Name

Sex

DOB

 

             

 

  

 

PA

 

 

Address

City

State

Zip

Home Tel. #

 

 

 

 

 

Mother’s Name

Father’s Name                       (or)

Legal Guardian’s Name

 

 

 

 

 

School District attending (in the Fall)

Grade (in the Fall)

Adult E-mail address (Mandatory)

 

 

Age as of August 1st

New Player(Never played soccer before)

 

Experienced Player

 

Circle One

Approximate # of Years Played

 

________

Primary Positions played

 

______________

We understand that the League carries only minimal health insurance on each child.  We agree to use our private health insurance as the primary source of payment for medical care.

We the parents of ____________________________________________________________ give permission for emergency medical treatment of our child for illness or accident if we can’t be first contacted.

1st  Person to notify other than Parent/Guardian: _________________ _____________ Tel: _______________________

2nd Person to notify other than Parent/Guardian: ______________________________ Tel: ________________________

Does your child have any allergies or any special medical conditions that the coach needs to be aware of:    No     Yes

Explain: __________________________________________________________________________________________

In order for your child to participate, a signed registration form and fee  must be received by June 15th .  Player registration fee will be $50 if no uniform is required.  All subsequent children in the same family will pay $30 each for registration.  Uniform fee is $20 (Shirt, shorts, and socks).  New shirts($10 yellow or reversibile, $15 blue), shorts($10) or socks($5) may be purchased separately for returning players.  Please fill out a registration form for each participating child.  An application and all financial obligations to the league must be satisfied before your child may participate in practice sessions or play in a game.

 

Help the league by volunteering as a:

 Head Coach

 Asst. Coach

 Referee Adult

 Field Worker

 

 

 

 

We hereby agree that Valley Youth United Youth Soccer Inc., its members, coaches and officers shall not be liable for injury of loss, which my child may sustain while participating in any Valley Youth United Youth Soccer activity. 

 

Parent / Guardian’s Signature: _________________________________________ Date: _____________________

 

Please mail this form, along with a check for all participating players registration and uniform fees, payable toValley Youth Soccer  by June 15, 2012. 

Send payment to:

 

Valley Youth Soccer Registration

7 Blythe Drive

Peckville, PA 18452

 

.................................................................................. Do not write below - Soccer league use only..  .................................................................................

Total Fee Paid

League Fee for this child

Payment Type (Cash or Check#)

Received By

Date

$

$

 

 

 

 

 On database______    Received by Treasurer______   Copy for coach_____  Ok’d______ #_______

 


Handout: Rules

Wednesday, June 6


 

 

 

M  /  F

 

 

First Name

MI

Last Name

Sex

DOB

 

             

 

 

 

PA

 

 

Address

City

State

Zip

Home Tel. #

 

 

 

 

 

Mother’s Name

Father’s Name                       (or)

Legal Guardian’s Name

 

 

 

 

 

School District attending (in the Fall)

Grade (in the Fall)

Adult E-mail address (Mandatory)

 

 

Age as of August 1st

New Player(Never played soccer before)

 

Experienced Player

 

Circle One

Approximate # of Years Played

 

________

Primary Positions played

 

______________

We understand that the League carries only minimal health insurance on each child.  We agree to use our private health insurance as the primary source of payment for medical care.

We the parents of ____________________________________________________________ give permission for emergency medical treatment of our child for illness or accident if we can’t be first contacted.

1st  Person to notify other than Parent/Guardian: _________________ _____________ Tel: _______________________

2nd Person to notify other than Parent/Guardian: ______________________________ Tel: ________________________

Does your child have any allergies or any special medical conditions that the coach needs to be aware of:    No     Yes

Explain: __________________________________________________________________________________________

In order for your child to participate, a signed registration form and fee  must be received by June 15th .  Player registration fee will be $50 if no uniform is required.  All subsequent children in the same family will pay $30 each for registration.  Uniform fee is $20 (Shirt, shorts, and socks).  New shirts($10 yellow or reversibile, $15 blue), shorts($10) or socks($5) may be purchased separately for returning players.  Please fill out a registration form for each participating child.  An application and all financial obligations to the league must be satisfied before your child may participate in practice sessions or play in a game.

 

Help the league by volunteering as a:

 Head Coach

 Asst. Coach

 Referee Adult

 Field Worker

 

 

 

 

We hereby agree that Valley Youth United Youth Soccer Inc., its members, coaches and officers shall not be liable for injury of loss, which my child may sustain while participating in any Valley Youth United Youth Soccer activity. 

 

Parent / Guardian’s Signature: _________________________________________ Date: _____________________

 

Please mail this form, along with a check for all participating players registration and uniform fees, payable toValley Youth Soccer  by June 15, 2012. 

Send payment to:

 

Valley Youth Soccer Registration

7 Blythe Drive

Peckville, PA 18452

 

.................................................................................. Do not write below - Soccer league use only..  .................................................................................

Total Fee Paid

League Fee for this child

Payment Type (Cash or Check#)

Received By

Date

$

$

 

 

 

 

 On database______    Received by Treasurer______   Copy for coach_____  Ok’d______ #_______

 



   
Valley Youth United Youth Soccer Inc.
Valley Youth United Youth Soccer Inc.

 
 
 
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