West Valley Youth Soccer League

* Required Fields

PLAYER INFORMATION

Player Name*
First Mid Initial Last

Date of Birth (MM/DD/YY)* ---JanFebMarAprMayJuneJulyAugSeptOctNovDec//---20102009200820072006200520042003200220012000

Current Age* Gender* ---BoyGirl

School Grade

List medical conditions that could affect participation:

Emergency Contact*

Relationship to the Player

Emergency Phone(s)*:

Mother's Date of Birth (mm/dd, no year required)* /
(Used for a player registration code)

GUARDIAN INFORMATION

Guardian Type* ---FatherMotherOther/Legal

Guardian Name*
First Mid Initial Last

Home Address*

Home Phone* Cell Phone

Email*

We will be using email to contact about the program. Add other email contacts:
Email Name
Email Name

VOLUNTEERING*

We rely on volunteers to help with the program. We will provide coaching training, so no experience is needed, just desire. There is a $20 non-volunteer fee per combined family registration.
 Coach/Assistant Coach Setup and other help I am not able to volunteer**Name of Volunteer
**If you are not volunteering, add $20 to the registration fees.