Bellefontaine City Youth Soccer Association
Boys Soccer
2014 Registration Form
PLEASE PRINT:
Name____________________________________________________Date of Birth__________________
Address_____________________________________________Grade entering 14/15 school yr._______
Email Address: _______________________________________________________________________
Parent/Guardian Name__________________________________________________________________
Phone Numbers: Cell:______________________________Home:______________________________
**Are you playing another Fall Sport? Yes_______ No _______
If you have a sibling in your age group that you would like on the same team: Name____________ Grade: ____
WAIVER OF RESPONSIBILITY
It is understood that the City of Bellefontaine, the Joint District Park Board, Youth Soccer Association, employees,
volunteers, the organizers, sponsors and the supervisors, any and all of them are released, absolved, indemnified, and held
harmless in case of injury, accident or illness that may occur during the soccer season. I do assume all the risks and
hazards that are incidental to the conduct of the activities for the above named minor and understand that mouth guards
are worn at the parent’s discretion. I hereby waive all claims against and release from responsibility, any person
involved in the league.
Parent/Guardian Signature___________________________________________
Participation Fee: $30.00 – No Refunds - ________ PAID
(Checks made out to Bellefontaine Youth Soccer Association)
Shirt Size: Circle one –
Youth – S(6-8)
M(10-12)
L(14-16)
Adult – S M L
Late Registration Policy
After 6/30/14 - Additional $20.00- Payable to the Joint Recreation District
No registrations will be accepted after Friday August 1st
***Minimum grade- must be entering Kindergarten for 14/15 school year to play soccer.
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Tear off & Save this Portion Boys -Soccer
NOTE: Soccer will conflict with School Fall Sports and
Our Leagues are Co-Ed except for K-1
Skills Assessments will be held July 26th Southview Park
9 am – All 2nd and 3rd Grade
10 am – All 4th and 5th Grade
11 am – 6th, 7th and 8th Grade
All Players will be drafted to a team
Coaches will call players for practice dates