PEORIA SOCCER CLUB
WINTER FUTSAL SOCCER PROGRAM

Player Registration Form

You will be contacted by the Peoria Soccer Club
to confirm acceptance in the PSC Futsal Soccer Program
and which team you will be playing on.

PLAYER AGES: 6 - 16 years old
(born after 7/31/1995 and before 8/1/2004)
Players will be divided into teams based on age and skill level

PROGRAM COST:
$60 per session
(PSC players will receive $25 credit on their Spring dues)

SESSION II DATES: 2/12/2012 - 3/25/2012 (7 games)

SEE OUR WEBSITE: WWW.PEORIASOCCERCLUB.ORG
FOR THE PSC WINTER PROGRAM FLYER

Player First Name:

Player Last Name:

Player Birth Date:

Current Soccer Team and/or League:

Player T-shirt Size Requested:

Youth Small:
Youth Medium:
Youth Large:
Adult Small:
Adult Medium:
Adult Large:
Adult XL:

PSC Member Status:

Paid PSC Member:
Non Club Member:

Player Gender:

Boy:
Girl:

Indoor Soccer Sessions:

Session I:
Session II:
Both Sessions:

Contact Information

Parents' Names:

Address:

Street:
City:
State :
Zip:

Home Phone:
Cell Phone:
Cell Phone 2 (optional):
E-mail:
E-mail 2 (optional):
E-mail 3 (optional):

Other information we should know about your player including any special requests:

Player First Name:
Player Last Name:
Player Birth Date:
Current Soccer Team and/or League: Player T-shirt Size Requested:

Indoor Soccer Sessions:
Session I: Session II: Both Sessions:

Contact Information
Parents' Names:
Address:
Street: City: State : Zip:
Home Phone: Cell Phone: Cell Phone 2 (optional): E-mail: E-mail 2 (optional): E-mail 3 (optional):