YOUTH FALL SOCCER

The Fort Scott Recreation Soccer program is now being formed for the Fall Season.  Boys and Girls 4 years - 5th grade, MUST bring a $10 registration fee along with the form printed below to Buck Run Community Center before Friday, August 27, 200 4.  (after August 27th - $20.00).  Team shirts purchased for this program are included in this fee.

Players will be divided into the following age/grades for league play:

   (4 years)                                (K - 1st grade)                            (2nd - 3rd grade)                             (4th & 5th grade)     

Games will be played on Saturday mornings at the Kiwanis Fields (FSCC).  Games  begins September 18, 200 4.

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200 4 Recreation Fall Soccer Registration Form

Name ____________________________________________ Address_____________________________________________

Age _______ Birthdate _____________ Grade ___________      (Please Circle)         Boy or Girl

Parent (s) Name ____________________________ Day Phone __________________Home Phone_____________________

Shirt size  (circle one )   Youth        S          M          L                                      Adult         S        M        L

Do you have a sibling that will play in the same league?   Yes   No   If yes, Who? ___________________________________

No other request such as carpooling, friend or cousin will be accepted!

Would you like to be considered as a coach?_____, assistant coach?_____ or coach if needed?_____ (Please Check)

If so, please list daytime phone number_______________________________      

Please list any medical concerns that the FSRC and/or coach should be aware of?____________________________________

_____________________________________________________________________________________________________

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Parental Consent Form (SOCCER 200 4)

The undersigned parent(s) of ____________________________________________________________, a minor in consideration of his/her being permitted to participate in the Fort Scott Recreation program, do hereby freely and voluntarily give my (our) consent of such participation and hereby release Fort Scott Recreation, Inc., its directors, officers, employees, agents, any sponsors, organizers, or coaches from any and all claims or rights of action, which the undersigned or the said child may have or ever may have as a result of any act of omission of any such persons or Fort Scott Recreation, Inc.  The undersigned recognizes that the child will be engaged in a sporting activity and that there are certain risks involved in such an activity, including the risk of personal injury, and the undersigned assumes the risk thereof.

Parent/Guardian Signature

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