2. Soccer Registration Form

   The City of Creston Park & Recreation Department will be facilitating a youth soccer program for boys and girls in grades Kindergarten through 6th. Games will be played at Sear's Complex soccer fields with the first game to be scheduled in April. Registrations will be accepted now through March 31, 2023 at 5:00 pm.

   This program is NOT sponsored by the Creston Community School District. Parents should contact Mark Huff, Parks & Recreation Director, at 641-782-2000 ext. 208 or muff@crestoniowa.org if you have any questions.

4. Child's First & Last Name*
6. Address-Street, City, State and Zip Code*
8. Phone Number*
9. E-mail
11. Grade in 2022-23 School Year*
    -- Select One --Kindergarten1st2nd3rd4th5th6th
12. Gender*
    -- Select One --MaleFemale
13. Player Shirt Size*
    -- Select One --Youth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XL
15. Registration Fee (Includes Shirt)*
    -- Select One --$0.00 - Included with another form submission1 Child - $25.002 Children - $35.003 Children - $45.004+ Children - $50.00
16. Payment Method*
    -- Select One --On-lineCheck
17. Online Payments:
    Continue to GovPayNet

    (a small fee will be automatically applied)
    Return to form to complete and submit after payment!
    
    

19. If you selected payment by check, make checks payable to the Parks & Rec Department and mail to PO Box 449, Creston, IA, 50801. Your child will not be registered until payment is received.

21. The undersigned hereby releases the City of Creston, Iowa and the Park and Recreation Department and its employees, heirs and assigns from all liability as the result of any injury or damages that I or my child may suffer as the result of participation in the youth soccer program sponsored by the Creston Park & Recreation Department and the City of Creston.

23. Parent/Guardian E-Signature*
24. Date*
26. Coach/Officiate

    1. I am interested in coaching
    2. I am interested in officiating
27. Name & Phone Number

29. After the registration deadline, coaches and players will be assigned to teams. The coaches will be responsible for contacting players to notify them of practice and game times in April.

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field