YOUTH SOCCER - Greater Wichita YMCA

STEP
1.
PLAYER/PARENT INFO
Participant Name: ___________________________________________________________
Email contact for family: ___________________________________________________
Home Address: _______________________________________________________________
City: _______________________________________ State: _________ Zip: _____________
Sex: M F DOB:______/______/______ Age as of 9/1/14:________________
School Name: _________________________________________________________________
Parent/Guardian 1 Name: __________________________________________________
Home Ph: __________________________________Cell: ______________________________
Parent/Guardian 2 Name: __________________________________________________
Home Ph: __________________________________Cell: ______________________________
I want to be a volunteer: Coach Assistant Coach
Name: _____________________________________Phone: ___________________________
Participation Release
I release the Greater Wichita YMCA, its coaches and officials from all claims of
injury which may be sustained by above child while participating in any YMCAsponsored
activity, whether caused by the negligence of the YMCA or otherwise.
If medical attention is required, I give my permission for such medical care. I also
agree to follow the Greater Wichita YMCA sportsmanship standards and guidelines.
By signing below, I give the YMCA permission to use photographs or videos
of the above named participant in its promotional/educational materials.
___________________________________________ _
Parent/Guardian Signature
_________________________
Date
NEW! AGE DIVISIONS Now, register your child for a
sport by age. New age divisions allow you to:
• Grow with your team or favorite coach.
• Play on the same team as a sibling or friend.
• Place your athlete into an older division to encourage
higher skill development.
Ex: Jonah, age 5, wants to play on the same team as his
friend Bryce, age 6. Jonah could play in 6U but Bryce could
not play in 5U.
STEP
2.
OUTDOOR YOUTH SOCCER LEAGUES | 2014-2015
Register as individual players
Season Dates:
Register by: Practices Begin:
Season: Fall 2014 (9/6-10/25/14) | 7/28/14 | Week of 8/18/14
Spring 2015 (3/28-5/23/15) | 2/23/15 | Week of 3/16/15
Division: 4U* 5U 6U 8U 10U 12U
*4U does not have separate practices. Plays 30 minute practice followed by 30 minute game.
Host YMCA (circle one): A E N NW S W
Coach Request: _______________________________________ Friend Request: ______________________________________
Special Needs: ____________________________________________________________________________________________________
INDOOR YOUTH/ADVANCED SOCCER LEAGUES | 2014-2015
Season: 8 games
Register as a team, Min. 7 players
Player Fees: $40 Y Member
Season Dates: Register by: Practices Begin:
$60 Non-Member
Season: Fall I 2014 (9/20-11/8/14*) | 8/25/14 | Week of 9/8/14* Uniform: Y reversible jersey ($12 each)
Fall II 2014 (11/22-12/20/15) | 10/20/14 | Week of 11/10/14 Location: Games played on YMCA Farha
Winter 2015 (1/17-3/7/15) | 12/15/14 | Week of 1/5/15 Sport Center indoor turf fields.
Spring 2015 (3/21-5/16/15) | 2/16/15 | Week of 3/9/15 Features: 65,000 sq ft of turf, 6 youth
Summer 2015 (6/6-8/1/15) | 4/27/15 | Week of 5/18/15
fields, 2 adult fields, keeps players
working on the skills of the outdoor
*Schedule may change dependent on opening of YMCA Farha Sport Center - Indoor Fields.
game, no walls on fields.
Division: 4U 5U 6U 7U 8U 9U 10U 11U
Free Agents: Players without a team
12U 13U 14U 15U 16U 17U 18U
are placed pending availability. Players
Previous Team: _______________________________________League:_____________________________ Record: ___________
not placed are subject to full refunds.
ADVANCED LEAGUE - COACH USE ONLY: Full team payment and completed player forms must accompany roster for registration
Team Name: __________________________________________________________________________ Coach Name: ___________________________________________________________________
Address: ______________________________________________________ Phone: _______________________________________Email: ____________________________________________________
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SELECT YOUR LEAGUE
MICRO SOCCER (Ages 3-4) Join your child in their first soccer experience! Learn the fundamentals of the game together as
you have fun and make new friends. FEES: $24/4-week session (Sep '14 & Apr '15) Register online or at any YMCA location.
Player Name
Visit ymcawichita.org/sports to register online.
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Player Name
Season: 8 games
SAVE
$15
previously
$40
Player Fees: $25 Y Member
$60 Non-Member
Uniform: Y reversible jersey ($12 each)
Can be purchased at the front desk of any YMCA location.
Location: (A, E, N, NW, S, W)
Games played on outdoor fields.
Features: Players play 1/2 of each
game; volunteer coaches.
OFFICE USE ONLY
Program/Team Fee
Uniforms ($12/ea, Qty______ Size______)
Total Amount Due
Date: ____________________ Pmt: Visa MC Discover Check
Member #_______________________ Staff Name_____________________________________
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