North Kansas City Parks and Recreation
Spring Youth Soccer Registration Form 2017
2251 Howell, North Kansas City, MO 64116 / 816-300-0545 / www.nkc.org
Registration will be accepted Jan. 2nd through Feb. 3rd or until
teams are filled. Payment is required at time of registration.
REFUND POLICY: A refund can be requested up to two weeks
from the start date of league practice. The refund will be 75% of
the registration fee. NO refunds will be made after the two
week period.
LATE FEE POLICY: There will be a $10.00 late fee applied for
anyone registering after the deadline.
I AM REGISTERING FOR THE FOLLOWING DIVISION:
___ Division A: Currently in K or 1st Grade
___ Division B: Currently in 2nd or 3rd Grade
___ Division C: Currently in 4th or 5th Grade
___ Division D: Currently in 6th, 7th, or 8th Grade
Fees: A & B $55 / C & D $60 (includes T-Shirt and Trophy)
PLEASE PRINT ALL INFORMATION
Name of player_____________________________________________________________ Male _____ Female _____
Address ________________________________________________________________________________________
City ____________________ State _______ Zip Code __________ Age ______ DOB _______/_______/___________
School ____________________________________________________________ Grade Level __________________
Parent(s) Name ________________________________________ E-Mail____________________________________
Home Phone ____________________ Cell Phone _______________________ Work Phone _____________________
Did your child play soccer for North Kansas City in 2016? Yes____ No ____ Which Team _______________________
Shirt Size: YXS (6-8) ____ YS (8-10) ____ YM (10-12) ____ YL (14-16) ____ AS ____ AM ____ AL ____ AXL____
Does participant have any medical conditions that may need special accommodation/attention? Yes ____ No ____
Special accommodation request: ____________________________________________________________________
Children may register with one “buddy” for youth team programs. BOTH registration forms must be received along
with the registration fee for each child at the same time. If you are new to the NKC Soccer League, you will be placed
on a team by the NKC Parks & Recreation staff.
Buddy Name (If Applicable): ________________________________________________________________________
Other Comments: ________________________________________________________________________________
Volunteer Coaches Needed!
Volunteer coaches work with teams under the direction of North Kansas City Parks and Recreation Department.
Let us know if you are interested!
Yes____ No____ Head Coach____ Asst. Coach____
By signing the Registration Form, I acknowledge all risks of injury, illness, death, and property damage, and affirm that I have
assumed all responsibility of injury, illness, or death in any way connected with participation in the program. I also agree for
myself and for any child participant to follow all rules and procedures of the program and to follow the reasonable instructions of
the teachers and supervisors of the program.
Parent of Guardian Signature ________________________________________________ Date __________________
For Office Use Only: Fee Paid _________________
Type _____________ Team _____________