Pagosa Springs Youth Football Association
pagosaspringsyouthfootball.siplay.com
Post Office Box 2243
Pagosa Springs, CO 81147
EIN 81-0750356
PAGOSA SPRINGS
YOUTH FOOTBALL
2016 REGISTRATION FORM
FEES (POSTMARKED BY)
EARLY BIRD: $85 (NOW – JUNE 1) REGISTRATION FEE: $95 (JUNE 2 – JULY 27) LATE FEE $125 (JULY 28 – SEPT)
PAYMENT AMOUNT ___________ CASH OR CHECK # _________
PERSONALIZED JERSEY $50 (DUE BY JULY 27) CHECK # ________
EQUIPMENT DEPOSIT $100 (DUE JULY 29) CHECK # ________
Last Name _______________________________ First ___________________ MI _____
Home Address ______________________________________________________________
City ______________________________ State _________ Zip Code _________________
Date of Birth _____/_____/_____ Age as of 08/01/16 _______ Grade in the fall of 2016 ___
Jersey # Choice 1st______ 2nd______3rd______ (Must be paid for by July 26th)
Youth Size S/M (30-32) L/XL (34-36)
Adult S (34-37) M (38-41) (Please circle one)
Returning players can use the previous year’s jersey. Please put your child’s # __________ so it’s accounted for.
PARENTS/GUARDIAN INFORMATION:
Mother’s Name ____________________________ Home Telephone # _______________
Email Address _____________________________ Work/Cell # _____________________
Home Address if different from child _________________________________________
Father’s Name ____________________________ Home Telephone # _______________
Email Address _____________________________ Work/Cell # _____________________
Home Address if different from child ___________________________________________
REQUIREMENTS FROM PARENT:
Parents are required to DONATE 2 HOURS per player in volunteer hours for field setup/teardown, concessions,
chains, scoreboard, etc.
**Deposit of $100 for equipment required before any equipment will be handed out on July 29th.
This will be returned once you have returned the equipment in its entirety with normal wear and tear**
-----------------------------------------------------------------------------------------------------------Official use only- Registration Check List
Registration Form______ Fee ______ Equipment Deposit ______ Jersey Fee ______
Player & Parent Code of Conduct ______ Liability Forms ______
Copy of Birth Certificate ______ Physical Forms ________
Please send all Registration Forms & Fees to:
Pagosa Springs Youth Football Association
P.O. Box 2243/Pagosa Springs, CO 81147