2014 PREMIER  LEAGUE  APPLICATION

Required information is indicated by a red star *
Your Application is not complete until you fill in ALL required information and click the Submit button at the bottom of this page

Player(s) Information

  *Player #1 Player #2 Player #3
Last Name (e.g. Smith) *    
First Name (e.g. Susie) *    
Date of Birth
(mm/dd/yyyy)
*    
Boy or Girl *    
Division *    
Where he/she played
in Fall 2012
*    

Parent/Guardian Information

  *Parent/Guardian 1 Parent/Guardian 2
Last Name (e.g. Smith) *  
First Name (e.g. Tom) *  
  *  
I would like to
Volunteer as a
*  
Experience/Training
for this job
   

Address:  *   City *   State *   Zip *

Primary Phone:  * *   Other Phone: 

E-Mail Address: 

Comments: 

Registration Fee
$70 for all Players regardless of where they played during the Fall 2013 season.

Amount of Check $*   Check # *   Check Date *
Please make your check payable to AYSO Region 9. Include your child’s name (s) on the memo line.

Checks returned for non-sufficient funds will be subject to a minimum of a $25 penalty. Your child(ren) will not be placed until restitution is made.

Refund requests will only be accepted though January 11, 2014.

Return this Application to
1 to 3 copies of the completed application needs to be printed (1 copy for each Player you are applying for!).  Mail the application(s) and your check to:
AYSO Region 9
P. O. Box 4914
Thousand Oaks, CA 91359-4914
attn: Premier League

Notes/Parent Agreement
By typing in my initials here * and Submitting this form, I acknowledge my understanding that AYSO Region 9 is run completely by volunteers and that, without volunteers there will be no program for my child.

Returning this form does NOT exclude my child from consideration for an All-Star Team.

I will provide a copy of my child's or children's birth certificate(s) if they did not play in AYSO Region 9 during the Fall 2013 season. A copy can be mailed in with this application.

DEADLINE FOR APPLICATIONS IS DECEMBER 5th, 2013

Check your work then Submit
1) Make sure that all information is correct and complete and that you have initialed the box above.
2) Click the Submit button below to complete your application.
If your information was completed correctly, after you click the Submit button you will see a Confirmation Page.
Print 1-3 copies of this page.

 


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