2014 Delaware Select Soccer Club Team Administrative Form Only - Payment 2 of 2
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 #2: You selected to pay your fee's in 2 separate payments. Your first payment was due with this registration. Your second payments will be due by October 31st.
Payment Options:
Payment #2 of 2 Equal Payments
Please note that a $5.00 Paypal admin fee will be charged for each payment made.
Original Registration Fee:
2nd 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
