MOUNT PENN SOCCER CLUB FALL 2017 REGISTRATION
PLAYER INFORMATION
Player Name:
Parent/Guardian Email:
Player Date of birth:
Parent/Guardian Phone:
Address:
 Boy
 Girl
 New Player
 Returning
Travel PlayerJersey # _____if you have a
uniform
Shirt Size:
PARENT/GUARDIAN INFORMATION
Parent/Guardian (1) Name:
Relationship to Player:
Email:
Preferred Phone:
Other Phone:
Parent/Guardian (2) Name:
Relationship to Player:
Email:
Preferred Phone:
Other Phone:
Emergency Contact Name:
Relationship to Player:
Email:
Preferred Phone:
Other Phone:
COST AND PAYMENT INFORMATION
U8 Players​: $60 (includes t-shirt and socks)
U8 player evaluations
First letter of the last name
U9 and older​: $80
Parents will need to provide a copy of the player’s birth
certificate and a picture at time of registration.
New​ U9 and above will need to purchase a uniform.
Uniform purchases can be made directly at
A-H Tuesday August 8th 5:00PM
I-P Tuesday August 8th 6:00PM
Q-Z Wednesday August 9th 5:00PM
The Soccer Stop
1802 State Hill Rd.
Wyomissing, PA 19610
PH 610-378-5575
Please have your child prepared with shin
guards,soccer cleats and water.
In the Event of Rain
Evaluations will take place at
Mt.Penn Elementary school Gym
**PARENT COACHES NEEDED TRAINING PROVIDED**
EMAIL: ​[email protected]
MAKE CHECK PAYABLE TO: MOUNT PENN SOCCER CLUB -NO REFUNDS
CONSENT GIVEN: If my child needs emergency medical care and no parent/guardian or emergency contact can
be reached, I give my consent for the transportation of my child by ambulance and for the administration of any
treatment deemed necessary by a medical professional.
____ Yes ____ No
I hereby grant permission to Mt.Penn Soccer Club representatives, to take and use: photographs and/or digital
images of my child for use in news releases and/or promotional materials. These materials might include printed
or electronic publications, web sites, or other electronic communications. ____ Yes ____ No
Are you willing to help coach / assistant coach / team parent ? _____Yes_____No
Medical Conditions:
Name of parent/guardian:
Signature of parent/guardian:
Date:
Return this form and payment ​no later than June 16, 2017​ to:
Official Use Only: Payment Received
/
/
Amount $ ​
_
​Check#​
​or cash League/Age Group______