ILLINOIS RIVER VALLEY SOCCER ASSOCIATION

2015 FALL REGISTRATION

REGISTRATION DEADLINE IS JUNE 27, 2015

Mail to: IVRSA PO Box 409, Seneca, IL 61360 or

In house registration: June 6 and June 13 from 9-11 @ Manlius Township Building
www.facebook.com/senecayouthsoccer

Checks payable to IRVSA. Please note a $25 fee will be assessed for NSF.
Please add $25 to registration fee if postmarked/received after June 13. No refunds after uniform order has been placed.
**Please note one child per registration **Birth certificate must be included with this registration form
Player: ___________________________ Sex: M or F Birthdate: __________________ Age on 7/31/15: ________
Address: ____________________________________________ City:_________________ Zip: ________________
Parent/Guardian: _________________________________________________ Phone: _______________________
Email: ______________________________________
Parent/Guardian: _________________________________________________ Phone:________________________
Email:______________________________________
Emergency Contact: _______________________________________________ Phone: _______________________
(other than yourself)

Medical Conditions (including asthma, allergies, etc.): __________________________________________________

Age Divisions: Select the division based upon your childs age as of July 31, 2015.
_______ U6--$50

(ages 4 and 5 years old at time of registration) (Please mark size for shirt only)

_______ U8--$50

(ages 6 and 7 years old at time of registration) (Please mark size for shirt only)

_______ U10--$75

(ages 8 and 9 years old at time of registration) (Please mark size for shirt and short)

_______ U12--$75

(ages 10 and 11 years old at time of registration) (Please mark size for shirt and short)

_______ U14--$100 (ages 12 and 13 years old at time of registration )(Please mark size for shirt and short)
Uniform Size: Available options in both Jersey and Shorts, please circle one for shirt and short if applicable:
Shirt Size: YS YM YL AS AM AL AXL
Short Size: YS YM YL AS AM AL AXL
FILL OUT BOTH SIDES OF THIS REGISTRATION FORM
Illinois River Valley Soccer Association Use Only:
Received by: __________ Date: ______________ Check #:_______________ Cash: ______ Amount:___________ BC: ________________

2015 Illinois River Valley Soccer Association

Fall Sign-Up Registration
We hereby agree that the Soccer Association for Youth (SAY), its members, coaches or officers shall not be liable for any injury or loss which
my child may sustain while participating in activities of any kind while sponsored by or under the supervision of SAY and we agree to indemnify

and hold harmless SAY, its members, coaches, officers or designates of any kind from any claim whatsoever. We hereby give permission for
emergency medical treatment of our child for illness or accident if we cannot first be contacted. We hereby consent that photo images of our child
may be used for IRVSA advertising via social media or newspaper releases. We have read the IRVSA 0 Tolerance Policy.
Parent/Guardian Signature:
___________________________________________________Date:_____________________________________
FALL Tournament:
The U10, U12 and U14 levels will be competing in the end of season Morris Tournament (dates to follow) if there are enough players to fill a
squad. The tournament is not mandatory but a fun way to end the season. If you think your child would like to participate in the tournament
please sign below and include the $15 tournament fee with your registration. If your child does not end up playing in the tournament a refund
will be given at the end of the season.
Yes my child would like to participate in the tournament:_________________________________________________________________
VOLUNTEERS:
IRVSA is always looking for volunteers for the following positions:
Coaches, Referees, Board Members, Field Set-Up, Equipment & Safety. If you feel you would like to assist in the fall session please provide
your contact information and how you would like to volunteer. All IRVSA coaches, referees and board members will be asked to fill out a
Background Check Release Form.
I would like to volunteer for IRVSA, please contact me:________________________________________________
I would like to volunteer as: ________________________________________________________________
REQUESTS:
We cannot guarantee times and places of practices, which are set by the teams coach. Teams are selected by a blind draft. Siblings in the same
division will be placed on the same team unless otherwise requested by parent. Players with August birthdays may ask to play in the same
division as their school classmates. All requests must be approved by the board and requested at registration.
Any request for a player to Play-Up in an older bracket must be presented to the Soccer Board, in writing, at the time of registration. Players
may only play-up one year (an 11 year old may request to play at U14 level, a 10 year old may not). Play-ups will be denied once roster
reaches 15 players.
Please make requests here: _________________________________________________________________________
_______________________________________________________________________________________________

No child will be excluded from participation in the IRVSA based on sex, race, nationality, or disability.

IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT:

Margi Weber (815) 357-1145 or
Heather Hartwig (217) 519-0440