OUR GOAL IS
FUN FOR ALL
Youth Soccer (Ages 5-12)
EAST VALLEY FAMILY YMCA
EAST VALLEY FAMILY YMCA YOUTH SOCCER REGISTRATION FORM
(One form per person, please print clearly)
Name (First & Last)
Birthdate
/
/
Age
❑ Male ❑ Female
Address
City
Zip
Parent/Guardian
Day Phone
/
/
Mobile Phone
/
/
Email
Y communication to parents will be via email.
I have read and understand the cancellation and make-up policy:
Initial
Date
INDICATED SIZE (please circle selected size):
YXS YS YM YL AS AM AL AXL AXXL
Note to Parent/Guardian: I hereby certify that the above named child is in normal health and capable of participating safely in
youth sports at the Y. I grant permission for the above named child to participate in this program.
Date
$
$
$
Ages 5 - 12
❑ Ages: 5-7 ❑ Ages: 8-12
Facility Member: $104
Program Member: $130
Practices:
Monday: 5-7 years old
Friday: 5-7 years old
Wednesday: 8-12 years old
Friday: 8-12 years old
❑ 5 pm - 6 pm
❑ 6 pm - 7 pm
❑ 5 pm - 6 pm
❑ 5 pm - 6 pm
❑ 6 pm - 7 pm
❑ 6 pm - 7 pm
Games:
Saturday, time to be announced
Office Use Only:
Received By:
Date
/
/
Payment Type:
❑ Check ❑ Credit Card ❑ Cash
For Details call 408-715-6500 or email [email protected]