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2017 Wells County Fall Youth Co-Ed Soccer
Sponsored by Northern Wells Soccer Club, Inc.
Registration: Complete both sides
Player
Name
Guardian
Name(s)
Street
Address
Age on 3/1
Sex
M or F
Phone
Number(s)
Shirt Size
YS
e-mail
YM
YL
AS
AM
AL
AXL
Email is used for changes in dates,
games, picture times, etc.
Family member requests (Immediate only, no guarantees)
Please indicate age division below (use age on 3/1)
U5 Division (4 to 5 yrs. of age)
U8 Division (6 to 8 yrs. of age)
U11 Division
U15 Division
(9 to 11 yrs. of age)
(12 to 15 yrs. of age)
The Northern Wells Soccer Club and its board members are independent and completely voluntary. We ask that you be willing
to volunteer some of your time as well. Please consider and indicate your interest below:
Please list name and contact number: ___________________________________ Coach Shirt Size ________
Coach
Asst. Coach
Either
(If you're selected: Coach: 1 FREE Child / Asst. Coach ½ price on 1 Child, fees will be refunded after selection)
Can help with field set up on Saturday, July 15th: (circle one)
yes
no
Name and Phone #: ________________________________________________________
Please complete both sides
For questions please call after 5pm:
Dan Batdorff
(260) 515-2492
No calls prior to July 9th regarding team selections.
Coaches are given until July 11th to contact players.
www.facebook.com/groups/NorthernWellsSoccerClub
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When: Games run from mid-August through late September/early October
U5: Sat AMs; U8 & U11: Sat AMs U15 Sat AMs & possible a couple weekday PMs

Where: Ossian Elementary School soccer fields (behind the school)

Schedule: Registration Deadline: June 10
**$15 late fee if postmarked after 6/10**
Team Set Up: Last 2 weeks of June
Practice Begins: Week of July 17th (Coaches will contact you with dates and
times. Cannot begin prior to field set up on July 15th)
First Games: Saturday August 12th
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Equipment:

Registration Fee: $50 per child (family discount - $50 for first child; $40 for each additional
Shoes (no toe cleats: baseball shoes) and shin guards. (Jerseys and socks
are provided.) Will have a “trading table” for gently used soccer equipment-leave what doesn’t fit,
take what does. Sizes/quantities limited. Trading table June 3rd and 10th at sign up.
child).
**$30 NSF for ALL returned checks**
Emergency and Health Contact Information:
Name___________________________________ Phone #: ____________________________________
Name___________________________________ Phone #: ____________________________________
Please indicate below any physical impairment or disability the coach and the league needs to be aware of:
Release Agreement & Authorization:
I hereby release and discharge NWSC and all of its board members, officers, coaches, volunteers or designees of any kind from
any liability for any claims I have, or may have because of injury to the above child as a participant in the soccer program or while
participating in activities of any kind. I fully realize that injury or illness to my child could result from or during participation with the
NWSC. In case of such accident or illness, I give permission for my child to be given medical treatment as deemed appropriate. I
will assume financial responsibility for any medical services provided for said child.
I give NWSC permission to use photos taken at events to be used for the sole purpose and at the discretion of NWSC for
advertising purposes.
Parent or Guardians Signature________________________________________Date_________________
Printed Name______________________________________________Relationship__________________
The Northern Wells Soccer Club is not affiliated with the Northern Wells Community Schools.
Mail completed form by June 10 to:
Northern Wells Soccer Club Inc.
PO Box 171
Ossian, IN 46777
How did you hear about this league/receive a
registration form?
School ____ Signs ____Friend ____
Previous player _____ Other ____ (explain below)
PARENT’S PLEDGE
I pledge to:
(1) Encourage my child/children to show respect to the coaches, players, referees and
spectator both on the field and off as I set that example by showing my respect to
coaches, players, referees and spectators
(2) Have my child/children at practices and games at the given times or contact the coach to
let him/her know of the situation
(3) Be supportive and encouraging to all players, both on and off the field
(4) Understand that this is an instructional league and that the safety of all players is the
league’s top priority. Given that fact, slide tackles/slide kicks are FORBIDDEN in this
league and penalties will be given for this behavior. I will stress the importance of following
this rule to my child/children
(5) Leave the coaching up to the coaches, the officiating up to the referees and the
decisions/rulings up to the Northern Wells soccer board.
_______________________________
______________________________
_______________________________
Parent(s) printed name
______________________________
Parent(s) signature/date