AYSO 159 Registration

July 2010

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My child is interested in playing Spring soccer. I understand that not all players that sign-up will be placed on a team due to the limited number of volunteer coaches. Coach and referee classes will be provided prior to the start of Spring play.

PLAYER INFORMATION
First	Last	played Fall 2009 in Region 159?
		YesNo
Gender	Birth Date
MaleFemale	mm/dd/yyyy

PARENT/GUARDIAN 1
First	Last

Primary Number	Secondary Phone
E.x. 111-111-1111	E.x. 111-111-1111
Email	willing to volunteer?
	Coach YesNo	Referee YesNo

PARENT/GUARDIAN 2
First	Last

Primary Number	Secondary Phone
E.x. 111-111-1111	E.x. 111-111-1111
Email	willing to volunteer?
	Coach YesNo	Referee YesNo

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PLAYER INFORMATION

PARENT/GUARDIAN 1

PARENT/GUARDIAN 2