Indoor Soccer 2020 will be played at the Y-Center's Multi-Sports Complex
Games February 22 - March 25, 2020
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. 2020
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:
If you have any questions, call Gary Lincoln (979-4336)