SCSHA NEW PLAYER REGISTRATION
FALL SEASON
PLAYER’S
NAME:______________________________________________ SEX:
M F
(LAST NAME)
(FIRST NAME) (MIDDLE
IINITIAL) (CIRCLE ONE)
DATE OF BIRTH__________ ___
(MONTH/DAY/YEAR)
ADDRESS
____________________________________________________________________
CITY
________________________________STATE __________ZIP CODE _____________
HOME PHONE (_____)_________________ ALT. PHONE (______)_________________
FATHER’S NAME
__________________________________________________________
(LAST NAME) (FIRST
NAME)
MOTHER’S NAME __________________________________________________________
(LAST NAME) (FIRST
NAME)
PLAYER’S
POSITION__________________
SHOOTS : RIGHT LEFT
DOES PLAYER WISH TO BE A
GOALIE? YES or NO
CIRCLE ONE)
TEAM OR ASSOCIATION PLAYED
FOR LAST SEASON_______________________________
*** Mite through Midget Players ***
All players from Mite
through Midget. Non-refundable regular
registration fee of $125.00 per player/$250.00 per family must accompany this
form.
MAIL THE COMPLETED APPLICATION AND
A COPY OF THE PLAYER’S
BIRTH CERTIFICATE TO:
S.C.S.H.A. REGISTRAR
P.O.
THIS AREA FOR SCSHA LEAGUE USE ONLY
POSTMARK DATE________________________ DIVISION/AGE CLASSIFICATION__________________________
ALL PLAYER
REGISTRATIONS WILL ONLY BE
ACCEPTED FROM
THE S.C.S.H.A. P.O. BOX
PLAYER
REGISTRATION MUST INCLUDE THE FOLLOWING OR WILL BE RETURNED:
1.)
COMPLETED REGISTRATION FORM
2.) CORRECT REGISTRATION FEE CHECK OR MONEY ORDER MADE PAYABLE TO S.C.S.H.A.
MAIL COMPLETED REGISTRATION FORM
AND PAYMENT TO:
S.C.S.H.A.
P.O.
.