Soccer Registration Time (Deadline June 14, 2013)

St. Thomas Aquinas CYO SOCCER REGISTRATION TIME (DEADLINE JUNE 14, 2013) The STA CYO is now accepting registrations for our soccer program for grades Pre-K thru twelfth grade (9-12 th grade girl’s team only). Teams will be built on a first come, first served basis. Practices begin in August and the season runs from September to the end of October. We provide uniforms (shirt, shorts and socks). Home games & practices are held at the FDR school fields. Children in Pre-K to 2nd grade do not need to be STA parish members to participate. Children in grades 3rd thru 12th must be registered within the parish and to do so you can contact the parish office at 215-788-2989. Registration Fees How To Register Early Registrations Grade Fee Complete and sign a form for each child. received before 6/14/13 Make checks payable to St. Thomas Aquinas CYO. PreK - 2nd $75 $60 A $35 fee is applied to all insufficient funds checks. 3rd - 8th $105 $90 Mail form and registration fee to CYO Treasurer: 9th - 12th $120 $105 Shannon McCormick, 809 First Ave, Croydon, PA 19021 NOTE: For 2 or more registrations from same household, deduct $10 from each player’s registration fee. If registering after June 14, a $15.00 late fee will be applied to the original fee. For questions, contact the Athletic Director: Kelley McCormick, [email protected] PLAYER INFO: Child’s Name:______Address:______Street City, State Zip Phone:______Email: ______

Birth date:______/______/______Age:_____ Male or Female Township:______

Grade DURING sport: ______School: STA Other______Uniform # preference____, 2nd choice ____ ------UNIFORM SIZE (Youth X-Large would be an Adult Small) SHIRT SIZE Youth Small Youth Med Youth Large Adult Small Adult Med Adult Large Adult X-Large ------SHORT SIZE Youth Small Youth Med Youth Large Adult Small Adult Med Adult Large Adult X-Large PARENT/GUARDIAN INFO: Father/Guardian:______Mother/Guardian: ______Emergency Contact: Name: ______Phone:______Parent/Guardian can help with: Head Coach Ass’t Coach Team Mom If medical conditions affecting child, which the coach should be aware, write details on reverse side of this page? No RELEASE STATEMENT Archdiocesan CYO guidelines require that any child in the third grade and above (soccer and track) and 4 th grade and above (basketball), must be a registered member of St. Thomas Aquinas Parish or attend the parish school in order to participate in the parish CYO program.

As parent or guardian of the above named child, I agree to identify and save harmless St. Thomas Aquinas Church, School and CYO, their Priests, Teachers, Coaches, Advisors or Employees from and against all lost of expense (including cost and attorney’s fees) by reason of liability imposed by law upon the Parish for damages because of bodily injury, at any time, incurred by the above named child while he or she is participating in CYO related activities or on account of damage to property including loss of use thereof arising out of or in consequences of the use of St. Thomas Aquinas Church, School or CYO facilities, whether such injuries to persons or damage to property is due to or claimed to be due to the negligence in whole or part of the organization, the St. Thomas Aquinas School or CYO, their Priests, teachers, Coaches, Advisors or Employees. The undersigned parent or guardian hereby acknowledges that she or he has or will provide appropriate Health and Accidental Medical Insurance to cover the above named child against any and all personal injuries sustained while a participant in any activity sponsored by the St. Thomas Aquinas CYO.

PHOTO RELEASE I,______hereby give the Archdiocese of Philadelphia, its successors and assigns and those acting with its authority, the unqualified right and permission to reproduce, copyright, publish, circulate or otherwise use any CYO event picture of my child produced by the Archdiocese of Philadelphia. This authorization and release covers the use of said pictures in any publicized form and any media of advertising publicity. I also understand that our school, CYO program or team sport may be identified by name and I fully understand that this is a complete release of all claims against the Archdiocese of Philadelphia or any other person, firm or corporation by reason of any such u se of pictures. I hereby warrant that I am free to give this permission. I further warrant that the information I have provided above is, to the best of my knowledge, true and accurate.

Date:______Signature of Parent/Guardian:______NO CHILD IS TO BE LEFT UNATTENDED AT PRACTICES OR GAMES cwalsh\CYO\2012 Soccer Registration Form 3/20/12