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Title: Microsoft Word - SOCCER-REGISTRATION-FORM-SPRING-2016.doc
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SOCCER PARTICIPATION RELEASE FORM
*** A PARENT OR LEGAL GUARDIAN MUST SIGN BELOW ***
***BEFORE THE CHILD WILL BE ALLOWED TO PARTICIPATE***
I/We do hereby waive any and all liabilities that the City of Hampton, VA,
and/or the Phillips Athletic Association, Inc., their agents or representatives may
incur as a result of any injury or other misfortune which may befall me/us and/or
my/our child/ward while engaged in the above named programs sponsored by
the Phillips Athletic Association, Inc.
I/We declare that I/we understand the risk involved in the above named
program due to the nature of the sport.
If I/we are not present, I/we agree to let the coaches with the Phillips Athletic
Association, Inc. care for my/our child/ward in the event of an emergency. I/We
declare that to the best of my/our knowledge and belief, my/our child/ward is in
good health and physical condition to participate in the above named program.
Signature of Parent/Guardian_____________________________________ Date:_______________
BE SURE TO SIGN ABOVE OR REGISTRATION FORM
WILL NOT BE PROCESSED!
I, ________________________________ (name), will help in the areas marked:
( ) Coach
( ) Assistant Coach
( ) Data Entry
( ) Team Parent
( ) Phone Calls
( ) Help at Registration
( ) Field Maintenance
( ) Help Initially Mark Fields
( ) Hang Soccer Nets
PLAYER FEE: $35.00 by 1/12/16, $45.00 after 1/12/16. Make checks payable to PAA. Forms received after
1/12/16 will be placed on a waiting list. Mail forms to PAA, 6 Hunter Trace, Hampton, VA 23669.
Complete if you will coach a team – one coach’s shirt provided. Additional coach’s shirts
can be ordered for $8. Payment is due before the shirt order goes in- please specify size)
Phone (H): ________________
Name: ____________________________________________ Phone (W): ________________
Phone (C): ________________
E-Mail Address: _________________________________________________________________
Age range you would like to coach:
Name and birth date of related player: ______________________________________________
Name of PAA team you last coached: ________________________________________________
Circle the days of the week you plan on practicing:
Time you plan to begin practice: ______________ Location of practice: _____________________
PAA SPRING SOCCER REGISTRATION -- Willow Oaks Library
Sat, Jan 9, 10:15 a.m. – noon & Tue, Jan 12, 2016, 5:00 – 7:00 p.m.
Or register by mail to: PAA
6 Hunter Trace
Hampton, VA 23669
Completed forms and fees must be received by Jan 12, 2016.
The on-time registration fee is $35.00 per player.
Registration will be held on the above dates/times
at the Willow Oaks Library. You may register
early by mailing or hand-delivering the completed
form to PAA, 6 Hunter Trace, Hampton, VA
23669. Checks will not be cashed before Jan 12.
Players between the ages of 4 through 18 may
register. Teams typically have a two to three-year
age span with the exception of the oldest age group
which has a larger age span. The birth year is used
to determine where players will be placed.
A separate registration form must be filled out for
each participant. One check may be written for
multiple registrations received by (not
postmarked by) Jan 12, 2016. Forms are
available at the Willow Oaks Library or thru the
web site of www.paaHampton.com.
Coaches will contact their team in early March and
begin practice shortly thereafter. Games will begin
at the end of March. Coaches determine the days
and times for practice. Practices and games are
held at places such as Gosnold's Hope Park, Syms,
Phillips, Jones, and the Hampton Soccer Complex.
Late Registration - The late registration
fee is $45.00 per player. Registrations received
after Jan 12, 2016 are late and should be mailed or
hand-delivered with a separate $45.00 check for
each participant. Include a self-addressed stamped
envelope so the check(s) can be returned if no
openings become available. Unfilled slots and
vacated slots will be filled by late registrants in
the order registrations are received. In other
words, those who get their forms and payment
in will be placed before those who call to be put
on the waiting list. Also, late registrants may
not get the shirt size requested and may be
moved as needed to balance the teams.
In order to balance the teams, requests for a
specific team or coach or requests to carpool
with a coach or a multiple number of players
will be ignored. Requests for carpooling with a
(only one) specific player will be considered only
if both players are in the same age bracket and
parity of teams can be maintained. Both
carpooling players must specify the name of the
other person on their registration form, and both
players will be entered into the draft. Siblings
in the same age group will be placed on the
same team and considered a carpool, but you
must provide the names of the siblings in the
comment section of the registration form so it
will not be overlooked.
Cancellation Policy - Cancellations must
be received in writing at the above address before
the end of the season for which you registered.
You must include the player’s name, birth year, a
self-addressed stamped envelope, and name that
will be on the refund check. Cancellations
received by Jan 12 will receive a full refund. After
this date, a pro-rated refund not to exceed $25 will
be given if the shirt, socks, etc. are returned and a
replacement player is found. Vacant slots will
be filled before replacements are made.
Players, except those in the youngest two age
groups, are re-divided every season to balance
Shirt Size (Circle):
Bottom line – requests may
not be honored.
Complete Registration Forms Accurately!
Incorrect information can result in your
child being placed on the waiting list!
Check Number ________
Registration Time Frame
SPRING SOCCER – Early January
BASEBALL - Late March to early April
FALL SOCCER – Late June to early July
Registration forms are available at the Willow
Oaks Library usually two weeks or more before
registration is held.
Mark your calendar…It's up to you!
Bring Used Items
If you have shoes, shin guards, or black
shorts, sweat pants, or warm-up pants that
you can no longer use, please bring them to
registration. We will line them up and let
everyone "shop" for a better size on Jan 9.
BE A SOCCER OFFICIAL!
Are you interested in being a soccer official?
You must be at least 13 years old by Mar 1, 2016
and be USSF certified. Certification classes for
soccer officials are offered periodically by the
Peninsula Soccer Officials Association.
Information on training sites and times can be
found at www.vadc.soccerref.com. For additional
information on becoming certified or officiating
for PAA, contact Sean Kent by phone at
757-831-4040 or by email at email@example.com.
The Phillips Athletic Association Board meets on the
last Monday of selected months at 7:30 p.m. in the
meeting room at the Willow Oaks Library. If you are
interested in becoming a Board member or attending,
please email firstname.lastname@example.org to find out if the
Board is meeting that month.
NEED INFORMATION ABOUT
Please speak slowly. Along with
your message, leave your name,
player’s name, date of birth, phone
number and email address. You will
be called back at a later date.
visit the PAA Website at
Phillips Athletic Association Soccer is a recreational
league. Its goal is to enable our youth to have fun while
developing positive values of cooperation, teamwork
and self-esteem in a safe and structured environment.
PAA Soccer is open to female and male youth between
the ages of 4 and 18. It is directed and staffed solely by
unpaid community volunteers. PAA is always seeking
volunteers for all aspects of the program. Some areas
of particular need are:
COACHES - Usually need coaches at all age levels. If you've
been an assistant, please consider coaching.
HELP AT REGISTRATION – Review registrations and
assist as needed
Name of Parent/Guardian: ________________________________________________________
Relationship to Player: ______________________________________________________________
Phone Number: __________________________
Alternate Phone Number: _______________
Street Address: ____________________________________________________________________
City: _________________________________________ State:
Zip Code: ________________
E-Mail Address: ________________________________________________________(PAA use only)
(Please Print Legibly)
Are you currently receiving PAA soccer info at this email address?
12 11 10 09 08 07 06 05 04 03 02 01 00 99 98 97
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Compared to other players your child's age, how would you rate your child?
Circle Skill Level:
Circle T-shirt Size:
Circle Sock Size:
Did the player participate in the 2015 PAA Fall Soccer Season?
(Sizes may vary)
If player participated in the 2015 PAA Fall Soccer and born in 2009, 2010, 2011, or 2012:
Would you like the same team? _____ … Or would you like to enter the draft?______
DATA ENTRY - Key in registration information in Excel and
transfer file over the Internet.
FIELD MAINTENANCE - Spread dirt on fields, anchor goals
PHONE CALLS - Make 10 to 20 calls on an occasional basis.
Phillips Athletic AssociationHampton, VA
Circle Male Female
Name Player is called (if different than first name above): ___________________________________
Circle Month of Birth:
or Facebook at
Player's Name: ________________________________________________
Must be 4 by Jun 30, 2016 and cannot be 19 years old before Mar 30, 2016
email@example.com for soccer
firstname.lastname@example.org for baseball
(Please Print Legibly)
Circle Year of Birth:
CALL THE PAA
24-HOUR INFORMATION LINE
SOCCER REGISTRATION FORM
Birth years 1997 - 2001, COMPLETE THIS SECTION:
MAINTAIN LINES – Paint the lines on fields.
Do you play goalie?
HANG SOCCER NETS – Hang and take down nets as needed
Do you play:
Select soccer ______
JV soccer ______
Varsity soccer ______
If you can help, note this on the registration form.
You must sign participation release form
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