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Chatham Soccer Academy 2010 Registration Form
Gender: Male ....... Female ........ Travel Team...( Yes or No )
Name of Player (first, last)
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Year Born: .............. Years Played: .......... School .....................................................................
Are you registered with Chatham Youth Soccer Association? ..... (Yes or No)
T-Shirt Size
YM ........... YL ........... YXL ............AS ............ AM ............
Address- (including Postal Code)
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Telephone number ...............................................................
Alternate Telephone number ..............................................
Date of Birth (MMDDYYYY) ...................................................
E- Mail address ........................................................................
Parent/Guardian Information
Names plus address, telephone number and E-mail if different from above
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Medical Information
Please provide details of any known medical condition relevant to competitive soccer
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Additional Information
Please provide details of any additional information that may be relevant
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Date ........................................................................ Signature ........................................................
Please mail completed application and cheque payable to "Dan Kennedy"
to:
Dan Kennedy, 20 White Birch Trail, Chatham, Ontario, N7L 5K3
Cost of Registration for players registered with an OSA registered club is $85. A $10 late registration fee will apply for registrations received after June 28th.
For players not registered with a club the cost of registration is $100.
Created by: Todd Armstrong -- Last updated:Jul 14, 2009
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