Wattles Park Men's Club - 2017 Fall Soccer Signup
ADDRESS ______________________________________ ZIP CODE 490 _____
PHONE NO. (primary) (269) _________________ PHONE NO. (secondary) (269) _________________
BIRTHDATE (month/day/year) ________
CIRCLE YOUR GRADE IN SEPT. 2017: PRE-K
K 1 2 3
4 5 6 7
(PRE-K means eligible for Kindergarten in September 2018 or September 2019)
SCHOOL THAT YOU ATTEND____________________ CIRCLE: MALE FEMALE
PARENTS'/GUARDIANS' NAMES ____________________________(please print)
Email address _____________________________________________________
_________ Enclosed is my check or money order for $50 made out to "WPMC".
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 reassuring to know that there's someone in the stands who might be able to help if an injury or emergency occurs. Please consider being available by circling your profession: Doctor, Nurse, Police Officer, Firefighter, E.M.T., or list any other category.
Please print out and mail this form
Make all checks payable to "WPMC".
Return to WPMC Fall Soccer Page.