South Montgomery Youth Soccer Club

Open to students from Kindergarten to 6th grade and Home schooled students age 4 through 13

Name____________________________ Phone _______________ Age ______ Birth Date _____________ Grade _______ Address ________________________________________________________________ City ______________________________, State __________ ZIP __________ Parents Names __________________________________________ Email address __________________________________ Emergency Contact Name _________________________ Emergency contact phone # ____________________________

School you would like to practice at: _______________________________________________ Uniform Size (circle one): YS YM YL AS AM AL AXL
REGISTRATION FEE: $35 for one child $25 for each additional child $70 max fee per family. Your club fee pays for a team shirt, shorts, and soccer socks! First Soccer Practice is September 7, 2011 @ 6pm at Lake Holiday Fields Please make checks payable to: South Montgomery Youth Soccer Club and mail to:

SMYSC
5556 S Imperial Blvd Crawfordsville, IN 47933 Questions? Contact: Jill Davis 866-8271 Jim Catalano 435-3757 Shane Worth 317-525-4830

Or E-mail us at smysc1@yahoo.com

Parents help make SMYSC work! Please volunteer to help! (circle any that apply): Coach Assistant Coach Field Set up Board Member School Representative

Special Requests: (Will be filled if possible)_________________________________________________________

SMYSC IS NOT RESPONSIBLE FOR ANY INJURY DURING PRACTICES OR GAMES

Registration Deadline: AUGUST 30, 2011

Any registration form turned in after the deadline will be subject to a $10 per child late fee! Soccer registration forms will not be accepted after team rosters have been set. Additionally, the team uniform will not be given to the child until the late fee is paid! See our website to

enroll and pay using Pay Pal. www.thesmysc.org