Wattles Park Men's Club - 2017 Fall Soccer Signup

NAME ___________________________________________________________

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    8    9
(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 _____________________________________________________

Please check:

_________ 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 to:                           Make all checks payable to "WPMC".

WPMC Soccer
C/o Gary Lincoln
13166 Eleven Mile Road
Ceresco, MI 49033

Return to WPMC Fall Soccer Page.