RIVER CITY INDOOR SOCCER CLUB       

3383 FREYS HILL ROAD * LOUISVILLE, KENTUCKY 40241-2121

(502) 426-9085     FAX (502) 426-0240

RIVER CITY'S LITTLE RASCALS

3,4,5 & 6 YEAR OLD CLINIC

YEAR ROUND - NEW SESSION EVERY 8 WEEKS

WHEN:  MONDAY AFTERNOONS

                        NOTE:  CLASS SIZES ARE LIMITED AND FILLED ON A FIRST COME, FIRST SERVE BASIS.

TIME: 4:00pm TO 5:00pm WITH 45 MINUTES SKILLS & 15 MINUTE MINI-GAME (numbers permitting)

NEXT SESSION STARTS: September 22 , 2008 

PRICE:  $70.00 FOR 8 WEEKS. RIVIE RACCOON LITTLE RASCALS T-SHIRT INCLUDED WITH CLASSES

WHAT TO WEAR:   WEAR SHINGUARDS WITH SOCKS THAT COVER THEM (ESPECIALLY PLASTIC                                               GUARDS), REGULAR SOLED TENNIS SHOES OR SNEAKERS, SHORTS OR                                                     COMFORTABLE SWEAT PANTS. NO CLEATS

 SOCCER BALLS AND SHIN GUARDS ARE SOLD AT RIVER CITY.

APPLICANT INFORMATION:

NAME:  PLEASE PRINT

LAST: _______________________ FIRST: ________________________ NICKNAME: _______________________

HOME ADDRESS: ______________________________________________________________________________

E-MAIL ADDRESS______________________________________________________________________________

CITY:  ____________________________ STATE:  ________________________ZIPCODE: ___________________

PARENT'S NAMES:  ____________________________________________________________________________

WORK PHONE:  _________________________________ HOME PHONE:  ________________________________

EMERGENCY CONTACT PERSON:  ___________________________________ PHONE:  ____________________

FAMILY PHYSICIAN:  ____________________________________________ PHONE:  _______________________

PARENT / GUARDIAN, MUST READ THE ENTIRE BACK OF THIS FORM WHICH IS A RELEASE FORM, BEFORE SIGNING BELOW.

MUST BE SIGNED BY PARENT/GUARDIAN BEFORE PARTICIPATION!

SIGNATURE OF PARENT / GUARDIAN:  _______________________________________ DATE:  ______________

A non-refundable deposit of $30.00 must accompany this form.  The remainder is to be paid the first clinic.  Spots are filled on a first come, first serve basis.  Entry forms are dated when received.  Deposits will not guarantee you a spot.  If we are unable to get your child registered because of too many, we will refund your money.