YOUTH FUTSAL REGISTRATION

Player’s Name: ____________________________________________________Male______ Female_______

Address: _______________________________________________Home Telephone_____________________

School: _____________________________________________Birthdate: Month______ Day_______Yr______

Soccer Experience (in years): ________ Recreation League: Current Grade (circle one), Pre K-K 1-2 3-4 5-6

Team League: Current Grade (circle one) 1-2 3-4 5- 6

___Yth 6/8 ___Yth 10/12 ___Yth 14/16 ____Ad Sm ____Ad Med ____Ad Lg ___Ad XL ___Ad 2X

(We/I) the undersigned (parent/parents) of __________________________________________do hereby consent that the above named minor may participate in the Farmington Community Civic Center Youth Futsal League. It is agreed that said League, its sponsors, officials or City assume no legal liability for injuries and the undersigned shall hold the City harmless from any actions brought against the City as a result of participation.

(Please sign and print name)

PARENT SIGNATURE_______________________________________________________________

PRINT NAME_____________________________________________________________________

DATE______________________________________

Registration Deadline: Sunday, December 13, 2009 or when league is full