Player name: 
Address:
Development:
City:
State:
Zip Code:
Telephone:
E-mail Address:
Date of Birth:
Gender: Male Female
Request:    (i.e. coach,friend,car pool with etc.)            
Volunteer:       Coach:   Field Prep:  Pictures:  Team Parent:
Name of Volunteer:
Father's Name: Occupation:
Mother's Name: Occupation:
Shirt sizes:Adult Extra smallAdult smallAdult mediumAdult largeAdult extra large  Shirt $18.00
Cost:1st child $40.002nd child $30.003rd child $24.00
$5.00 Discount if registraion is received before July 12.
$10.00 Discount to Head Coaches.

Liabilty/Medical Release
I hereby give my permission for my child to participate in the CAA soccer program. I certify that he/she is physically fit and that I will not hold CAA and/or representatives liable for any accidents and/or injuries incurred during the course of the season. I give permission to have my child transported and treated at any medical facity if injury is sustained or other medical services are required. I also understand that I will be responsible for payment of all such treatment. Please check if you give permission.

Enter Amount of Payment:

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          Check (check must be received within 14 days)

               Mail to CAA Soccer, PO Box 1157, Bear, DE 19701

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