Spring 2021 Registration 1st Parent Name* First Last 1st Parent Email* 1st Parent Cell Phone*2nd Parent Name First Last 2nd Parent Email 2nd Parent Cell PhoneAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWould you like to Coach a team? Head Coach Assistant CoachWould you like to be a team Mom or Dad? Team Mom Team DadHow did you hear about us?*Friend or Family MemberSeminole County School PlannerDaycare CenterLake Mary Life MagazineTreasure ChestOtherNumber of Children you are Registering*OneTwoThreeFourChild's Name* First Last Sex*MaleFemaleIf your child played in Fall 2020, do you want to remain on the same team?*YesNoDid not play in Fall 2020Date of child's birth* Date Format: MM slash DD slash YYYY Age as of 9/1/2020*School (If Applicable)Registration fee - Does NOT include a new uniformOne Child: $150Multi Child Discount: $145 eachHead Coach's Child: $75Assistant Coach's Child: $130Uniform Size - If new player or needs a new uniformNew Uniforms are $25. Please select a uniform size.No Uniform NeededYXS (4T - 5T)YS (6 - 8)YM (10 - 12)YL (14 - 16)Adult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-LargeNew Uniform Price: $25.00 Special RequestsSecond Child's Name First Last Sex*MaleFemaleIf your child played in Fall 2020, do you want to remain on the same team?*YesNoDid not play in Fall 2020Date of second child's birth* Date Format: MM slash DD slash YYYY Age as of 9/1/2020School (If Applicable)Registration fees - Second Child - Does NOT include a new uniformOne Child: $150Multi Child Discount: $145 eachHead Coach's Child: $75Assistant Coach's Child: $130Uniform Size - Second Child - If new player or needs a new uniformNo Uniform NeededYXS (4T - 5T)YS (6 - 8)YM (10 - 12)YL (14 - 16)Adult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-LargeNew Uniforms are $25. Please select a uniform size.New Uniform - Second Child Price: $25.00 Special RequestsThird Child's Name First Last Sex*MaleFemaleIf your child played in Fall 2020, do you want to remain on the same team?*YesNoDid not play in Fall 2020Date of third child's birth* Date Format: MM slash DD slash YYYY Age as of 9/1/2018School (If Applicable)Registration fees - Third Child - Does NOT include a new uniformOne Child: $150Multi Child Discount: $145 eachHead Coach's Child: $75Assistant Coach's Child: $130Uniform Size - Third Child - If new player or needs a new uniformNo Uniform NeededYXS (4T - 5T)YS (6 - 8)YM (10 - 12)YL (14 - 16)Adult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-LargePlease select a uniform size.New Uniform - Third Child Price: $25.00 Special RequestsFourth Child's Name First Last Sex*MaleFemaleIf your child played in Fall 2020, do you want to remain on the same team?*YesNoDid not play in Fall 2020Date of fourth child's birth Date Format: MM slash DD slash YYYY Age as of 9/1/2020School (If Applicable)Registration fees - Fourth Child - Does NOT include a new uniformOne Child: $150Multi Child Discount: $145 eachHead Coach's Child: $75Assistant Coach's Child: $130Uniform Size - Fourth Child - If new playerNo Uniform NeededYXS (4T - 5T)YS (6 - 8)YM (10 - 12)YL (14 - 16)Adult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-LargeNew Uniforms are $25. Please select a uniform size.New Uniform - Fourth Child Price: $25.00 Special RequestsIf your child played in the Spring of 2020 and did not use your Covid credit of $75, please email us at register@seminoleyouthsoccer.com and we will refund your credit card for the discount immediately.One Player - Late Fee Price: $25.00 Two Players - Late Fees Price: $50.00 Three Players - Late Fees Price: $75.00 Four Players - Late Fees Price: $100.00 Registration Fees Total $0.00 Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name When you click submit a copy of your registration information will be emailed to the 1st Parent email listed above. Please Note: Registration Deadline: January 23, 2021. There is a $25 late fee after this date Season Dates: TBA Refund Policy: ***No refunds after 1/23/21 ***There is a $25 processing fee for any and all refunds**
