Wattles Park Men's Club - Indoor Soccer Signup

 Indoor Soccer 2019 will be played at the Y-Center's Multi-Sports Complex

Games February 23 - March 27, 2019

 

NAME ________________________________________________________________________

PHONE (primary)____________________________(secondary) ___________________________

ADDRESS ___________________________________________ZIP CODE 490 ____

BIRTHDATE (month/day/year)  __________________    CIRCLE: MALE   FEMALE

CIRCLE YOUR PRESENT GRADE:   PK*   K    1    2    3     4    5    6    7    8  

PK* means eligible for K in Sept. 2019

SCHOOL THAT YOU ATTEND ______________________________

PARENTS'/GUARDIANS' NAMES _________________________________________________(please print names)

Email address ___________________________________________

PLEASE CHECK:

_________ Enclosed is my payment of $55.00

PARENTS' CHECK LIST:

_________ COACH (for my child's team)

_________ ASSISTANT (for my child's team)

_________ CONCESSION WORKER (one time only)

_________ MEDICAL PERSONNEL - Although rarely needed, it's nice to know that there's someone in the stands available to help if an injury occurs. If you identify yourself and an emergency occurs, we may contact you. Please circle your profession: Doctor, Nurse, Police Officer, Firefighter, E.M.T., or list any other category.

Please print out this form, include check or money order for $55 made out to "WPMC" and mail to:

WPMC c/o Gary Lincoln
13166 Eleven Mile Road
Ceresco, Michigan 49033

If you have any questions, call Gary Lincoln (979-4336)

Return to WPMC Indoor Soccer Page.