Monroe Youth Soccer Association

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Fall 2012 Registration With Check Or Cash

Please fill out form completly and click submit.

Form

1. Last Years Coach if Returning

2. Parents Names*

Personal Information

3. Player First Name*

4. Middle name*

5. Last Name*

6. Address*

7. Home Phone*

8. Cell Phone*

9. Email Address

10. Player Birth Date MM/DD/YYYY*

11. Male or Female*

	Male
	Female

12. Uniform Size*

13. AGE AT TIME OF REGISTRATION*

14. Parential Release*

I the undersigned parent or legal guardian of the above named child. Do hereby certify to the best of my knowledge that he/she is physically able to take part in the soccer program. I also agree to hold harmless the City of Monroe, its employees, instructors and volunteers. I agree to assume all risks and hazards incidental to the conduct of the program activity. Including transportation to and from the activity. I also agree to maintain a sportsman like behavior both on and off the fields as will the above named child during all activities. I also agree the above named child will complete the season with Monroe soccer or be penalized a 4 game sit out upon transferring to another association. (Union Soccer League Rule) 
As Parent or legal Guardian I The undersigned agree to the above.

I AGREE

15. I am interested in helping with?*

16. Fee Schedule*

PLEASE FILL OUT FORM COMPLETLY AND THEN CLICK SUBMIT. YOU WILL NEED TO SEND A CHECK FOR THE APPROPRIATE AMOUNT TO, 
MYSA c/o Christine Hullender 
3214 Downwind Dr. 
Monroe, NC 28110 
FEE SCHEDULE 
MICRO - NEW $50 
Players U7 & OLDER $90.00 W/Uniform 
We will be replacing our uniforms so all players will have to have a new uniform. Hopefully these will be able to be used 2 years. 
PLEASE LIST YOUR CHILDS NAME ON YOUR CHECK AND INCLUDE CHECK NUMBER ON THIS FORM.

I AGREE

17. Check Number & Date Mailed*

* required field

Lifespan
3127 Kalynne Street
Charlotte, NC 28208
www.lifespanservices.org
704-944-5112