Missaukee-Osceola Youth Soccer Registration Form
Sign-up for fall soccer: Ages 6-11 (Must be 6 - 11 years old on August 1, 2018)
Please contact David Skinner or Diane Eisenga at (231) 825-2492 for more information.
First name of child: *
Your answer
Last name of child: *
Your answer
First name of Parent(s)/Guardian(s): *
Your answer
Last name of Parent(s)/Guardian(s): *
Your answer
Mailing Address: *
Your answer
City: *
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Zip Code: *
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Primary Contact Phone: *
Your answer
Secondary Contact Phone:
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Email: *
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Participant Birth Date: (make sure year is correct) *
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Gender: *
Grade Entering this fall: *
Age on August 1st: *
Last Season Coach/Team (if applicable)
Your answer
School Attending: *
T-Shirt Size: *
MOYSA understands the need for some players to be on the same team for carpooling/sibling reasons. It is our desire for teams to be evenly sized and appropriately skilled for maximum sportsmanship and competition. Therefore, requesting special team placement must be approved by MOYSA. The safety of the child for the level he/she plays at will be our 1st priority. Please indicate below the name of the player/coach to be assigned with and the reason.
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Please check all that apply
Payment options:
$30 - if received in May
$35 - if received in June
$40 - if received in July
$45 - if received in August (We will only accept registrations in August if there is availability on teams)
Cancellation Policy: A cancellation request must be made by letter or e-mail. Refund requests must be received no later than July 15 for a full refund. Request received after July 15 will receive a refund minus a $15 cancellation fee. Requests received after August 1 will not receive a refund.
Please indicate form of payment: *
I/We, the parent(s) or guardian(s) of the above applicant, do hereby give my/our consent for the above named student to participate in the MOYSA Program under the above conditions. I/We will not hold MOYSA/NMCS, its sponsors, supporters, officers, coaches, teams, or anyone connected with the activity, responsible for any claim, including, but not limited, to injury, which the above applicant may incur while participating in this program. I have received the Rules and Responsibilities for Players, Parents, and Coaches and agree to abide by them as a condition for registering my child.I hereby grant MOYSA permission to use photographic images of me and/or my child(ren), in whole or in part, in promotional materials such as brochures and flyers and including the internet. PLEASE NOTE names will not be published with pictures on the internet. I hereby waive the right to inspect or approve the finished product or materials. I hereby release MOYSA and their representatives from any liability for any violation of any personal or proprietary right I may have in connection with the use of these images. *
Your answer
I/we acknowledge that I/we have reviewed the concussion educational information that meets Michigan Department of Health and Human Services requirements. *
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Note: Registration is not complete until payment is received.
Thank you for registering!
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