2015 Spring Delaware Select Soccer Club Team Administrative Form Only - Payment 4 of 4
Player's First Name:
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Player's Last Name:
*
Player's Gender:
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Male
Female
Player's Coaches Name:
*
Player's DCCS Team:
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U8 Academy
U-9 MOSSL
U-10 MOSSL
U-11 MOSSL
U-12 MOSSL
U-13 MOSSL
U-14 MOSSL
U-14 Buckeye Premier
U-15 MOSSL
U-15 Buckeye Premier
U-16 MOSSL
U-17 MOSSL
U-18 MOSSL
U-18 Buckeye Premier
Name of parent(s) or guardian:
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Name of parent(s) or guardian:
Daytime Phone Number:
Evening Phone Number:
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Cell Phone Number:
Email Address (used only for DYAA):
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Email Address (used only for DYAA):
Fee Structure:
U8 Academy for the Spring and Fall is $330. Admin will pay $165
MOSSL Registration Fee's for Spring and Fall is $650. Admins will pay $325
MOSSL Registration Fee's for U15-U18 Spring Season only is $330. Admins will pay $165
Buckeye Premiere Fee's for the Spring and Fall Season is $810. Admins will pay $405
Buckeye Premiere for the U15-U18 Spring Season only is $410. Admins will pay $205
Note: The registration fee for U8 Academy-U14 includes the Fall and Spring sessions. U15-U18 only includes the Spring.
Payment Option:
Payment plan #3: You selected to pay your fee's in 4 separate payments. Your second payment is due with this registration. Your Third payment will be due by October 31st. Your last payment will be due by January 31st. Email Notification will be sent out three weeks before your payment is due.
Payment Options:
Payment #4 of 4 Equal Payments
Please note that a $5.00 Paypal admin fee will be charged for each payment made.
Original Registration Fee:
4th Payment Amount Due Now:
Paypal Admin Fee:
Total Payment Due:
Authorization: On behalf of all participants in my immediate family I/we have read and agree to abide by the DYAA Code Of Conduct (which can be obtained on the DYAA web site at www.DYAASoccer.org). Furthermore, in consideration of my/our entry and registration of the player/participant hereby enrolled in the Delaware Youth Athletic Association and its youth soccer program, I/we and my/our legal heirs, individually and as the parent(s)/legal guardian(s) of the player/participant, do hereby waive and release all rights and claims for losses or damages that I/we and the player/participant may have against the City of Delaware and the Delaware Youth Athletic Association, its officials, sponsors, hosts, representatives, and administrators, for any and all injuries suffered by me/us and/or the player/participant in connection with participation in this program and all its events. I/we and the player/participant assume all risks of injuries, losses, and damages in connection with such participation. There is a $5.00 on-line registration fee included in this price to help offset bank charges.
Acknowledgement:
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I Agree
