2010 Online Registration at Covington Youth Soccer Association

Please complete and submit the following form:

Sunday, June 13th - Thursday, June 17th, 5:00 pm - 8:00 pm
Name:
Address:
City:
State:		Zip:
Email:
Age:			Boy Girl
Soccer Position:
Team/Club:
Parent Name:
Parent Phone:		Work:
Cell:		Pager:
Emergency Contact:
Emergency Number:
T-Shirt Size:	S M L	XL	Youth Adult

To complete this application, please remit the form containing the insurance waiver agreement and physician release with a non-refundable deposit of $50.00 by check. Balance is due at registration.