Child’s last name: _________________________________

1. The Salvation Army Youth Soccer League 2014Boys and Girls Grades K5-8thJanuary 13th, 2014- April 3, 2014FEE is $70.00 – Due upon registration.(Includes Jersey, socks, awards and 12 weeks of soccer) Child’s last name: _________________________________ Child’s first name: _________________________________ Date of Birth: __-__-__ Age:___ Grade:___ School:_______ Address: ________________________________Apt:_____ City:__________________ State: ________Zip:__________ Parent or Guardian Name: ___________________________ Email Address:____________________________________ Home Phone:_______________ Work Phone:____________ Child shirt size:____________ (Y / S-L) (Adult S,M,L) Any additional info: (anyone wanting to volunteer, coach, etc…) _______________________ Please Circle which night you would prefer for the appropriate age group: Monday nights: Grades K5-2 (limited to first 60) Tuesday nights: Grades K5-2 (limited to first 60) * Wednesday nights: Grades 5-8 (limited to first 60) Thursday nights: Grades 3-4 (limited to first 60) Game times 5 pm – 8 pm (except Wednesday) * 4:30 pm – 7:30 pm Practices will be held the first two weeks of the program. The weeks following will be games, days subject to change depending on enrollment. Each participant will be given a schedule at the first practice. Please return forms to THE SALVATION ARMY Registrations are due: Friday, JANUARY 10, 2014(Late registrations will be put on waiting list.)

2. Parental Consent:I agree to hold harmless the physicians, hospital, and other persons; including but not limited to The Salvation Army Oak Creek Centennial Corps Community Center (SAOC), staff and volunteers, who act upon consent for emergency medical care and/or treatment.I approve this application and certify that the applicant is capable of such an experience. No refunds will be given unless the league is canceled, and I understand that no refunds will be given if the child leaves because of an illness or injury.By signing this form, I certify approval of good health of the child and in the event that I cannot be reached in an emergency, I authorize the SAOC staff, and/or volunteers to render first aid.I understand that by signing this form, I agree to release the SAOC from any liability for the risk of illness, accidents, or injury.I give permission for the SAOC to hospitalize, secure proper treatment for and to order injections, anesthesia, or surgery for my child as named. (Attempts will be made to contact parent and/or guardian immediately.) Permission is also given to use any video or photographs that my child may be in for future SAOC use. I agree to waive any claims against the SAOC and its members, officers, employees and volunteers to injuries or damages that may result from the conduct of other persons, including participants in The SAOC league.By signing below, I agree to all consents written above.Parent and/or Guardian Signature: ____________________________ Date: ____________________________ Registrations are due by January 10, 2014Matthew Tregellas8853 S. Howell AvenueOak Creek, WI 53154(414) 762-3993