SAINT TERESA YOUTH ACTIVITIES ASSOCIATION (YAA) REGISTRATION FORM

Fall 2009/Spring 2010 Soccer Season

 

Child’s Last Name ________________           Child’s First Name______________          

 

Child’s DOB ______________      Gender     M     F      Shirt Size ____________        

 

Child’s School ___________________        CCD Site _______________________

 

Grade In Sept.  ________   Parish ID (Envelope) Number ___________________

 

Address (including zip) _______________________________________________         

 

Mother’s Last Name__________________ First Name______________________

 

Home Phone__________________   Mother’s Cell #_______________________

 

Mother’s E-Mail _______________________________________

 

Father’s Last Name__________________ First Name______________________

 

Home Phone__________________    Father’s Cell #_______________________

 

Father’s E-Mail _______________________________________

 

Emergency Contact ____________________ Relationship__________________

 

Emergency Contact’s Phone # ________________________________________

 

Sport Registering For _____________________ Cash Amt__________________

 

Year­­­­­­_________               Check #__________   Check Amt_________________

 

Please complete the above and return it along with the picture (if required), a copy of the birth certificate (mandatory for new players), and the appropriate fees to St. Teresa Soccer – c/o Glen Kartalis 131 Providence St. -  Staten Island NY 10304 – Additional information about the soccer program, can be found on the web site http://www.saintteresasi.org/styaa/soccer/STYAASoccer.htm . 

 

2009/2010 full year fees (Registration and fees are for both Fall and Spring seasons) -

1 player $120.00 – 2 players $190.00 – 3 players $260.00 –  Please make check payable to St. Teresa YAA - Soccer

 

By submitting this form, I certify that I have read and agree to the conditions of participations as contained in the “Term and Conditions” of the St. Teresa Soccer program, a copy of which is on the St. Teresa Parish web site at  http://www.saintteresasi.org/styaa/soccer/STYAASoccer.htm

 

 

 

Signature ____________________   Relationship to player ________________  Date _______