To be filled out by registration personnel
2017
Age Bracket ___________Gender________
Elks Recreational Soccer
Player Registration
Sheet
Payment: Cash/Check #_____________Amount______
Birth Certificate Yes/No/On File
Medical Release Yes/No
Cards Issued Yes /No
Team assigned to______________________________
Player Name__________________________________________________________________
First Name
Last Name
Middle Initial
Address _____________________________________________________________________
Street
Birth date: ___/___ /____
City
Male / Female
State
Zip Code
T-Shirt Size: YS YM YL AS AM AL AXL,
Circle School Player attends or will attend: Frohardt, Maryville, Mitchell, Prather, Wilson, St.
Elizabeth, Holy Family, Coolidge, Grigsby, ___________________________
Is player currently on a recreational team? Yes/No Do you want to return to that team? Yes/No
If yes, who is the coach?_________________________________________________________
If player is not currently on a team or does not wish to return to previous team – is there a particular
team that you would prefer to be on? Coach’s name ____________________________________
Have you verified with the coach that he/she has saved a spot for you on the team? Yes/No
Is player currently on a Club team? Yes/No If Yes, which one?________________________
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Mother: ______________________________________________________________________
First Name
Last Name
Middle Initial
Address ______________________________________________________________________
Street
City
State
Zip Code
Phone Number’s (___)________________________Cell Phone: (___)_____________________
Cell Carrier_________________________
E-Mail Address ________________________________________________________________
Print Email address – it will be used to keep players and parents updated about Soccer Schedules.
If you are interested in helping please circle the position? Coach Asst. Coach
Manager
What is your soccer background (have you played or coached before)? ____________________
_____________________________________________________________________________
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Father: _______________________________________________________________________
First Name
Last Name
Middle Initial
Address ______________________________________________________________________
Street
City
State
Zip Code
Phone Number’s (____)__________________________Cell: (___)________________________
Cell Carrier_________________________
E-Mail Address _________________________________________________________________
Print Email address – it will be used to keep players and parents updated about Soccer Schedules.
If you are interested in helping please circle the position? Coach Asst. Coach
Manager
What is your soccer background (have you played or coached before)? ____________________
_____________________________________________________________________________
Priority for placing players is by need, not by request. In spring players are allowed to switch teams.