PEORIA SOCCER CLUB

2011/2012 WINTER TRAINING REGISTRATION FORM

Winter training will be held on Saturdays
in the Ridgeview Elementary School Gym

Session II: 2/11/2012 - 3/24/2012

12:00 PM - 12:45 PM --- 4 - 6 years old (Peoria Futures)
1:00 PM - 1:50 PM --- 7 - 9 years old
2:00 PM - 2:50 PM --- 10 - 12 years old
3:00 PM - 4:00 PM --- 13 - 19 years old

Peoria Futures: $30 per session
U8 - U19: $60 per session
(PSC players receive $25 credit applied to Spring dues)

SEE OUR WEBSITE (WWW.PEORIASOCCERCLUB.ORG)
FOR THE WINTER 2011 / SPRING 2012 PROGRAM FLYER

Player First Name:

Player Last Name:

Player Birth Date:

Current Soccer Team and/or League:

PSC Member Status:

Paid PSC Member:
Non Club Member:

Player Gender:

Boy:
Girl:

Training 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:

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):