PO Box 508

Oyster Bay, NY 11771-0508

Open to all children 4 years of age.

Registration fee is $120 (make check payable to: OBEN Soccer Club)

Child's name_________________________Grade________________

Date of birth_____________Male__Female__School_____________

Parents' names_______________Address______________________

Town_______________State___Zip Code____Telephone #________

Boys and girls mixed division____________All girls division_______

If possible, we ask that you please help: Coach__Ass't. Coach______

Other help as needed________Donation $________________

Parent's Approval Agreement

I certify that my child, enrolled above, is in excellent physical health and may participate in strenuous physical activities, including soccer. Permission is hereby granted for my child to receive emergency medical treatment, if needed.

(Signature of parent)

A copy of the child's birth certificate is required at the time of their first registration. It will be kept on file for insurance purposes, as well as for entry to local tournaments.

Additional registration forms can be obtained at the Oyster Bay Library.