Erie Rec Youth Soccer Sign Up

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

Boy Girl

Participant Name:

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL

In consideration of the Erie Recreation Commission allowing me to participate in the Erie Rec Youth Bowling Program, I hereby, for myself and my heirs, wave all rights and claims for damages I may have against the Erie Recreation Commission, its agents and employees for injuries suffered by me in connection with the Erie Recreation Commission Youth Soccer Program.

Participant Signature

Date

By my signature I, the parent/guardian of the participant noted above, acknowledge that I have read the above release, and agree with its terms and consent to my child's participation in the Erie Rec Youth Soccer Program.

Parent Signature

Date

Email Address

Address

City

State

Zip

Home Phone

Cell Phone

Best Way to Contact You

Home Phone Cell Phone Email Home, Cell or Email

May We Text You?

Yes No

Birthdate

Does your child have any medical concerns, take any medications, or have any disabilities that the Recreation Commission and coach should be made aware of?

Grade

Sex

Shirt Size

Registration Deadline:  February 22nd

LEAGUE SOCCER - $20 ($25 after 2/22/12)

Pay Online via paypal

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