Rockbridge Area Recreation Organization (RARO)

300A White Street, Lexington, VA  24450

Mail to: P.O. Box 731, Lexington, VA 24450

Phone: (540) 463-9525 Infoline: (540) 463-1113

Email: rarorec@rarorec.org      Website: www.rarorec.org

 

2010 RARO YOUTH SOCCER REGISTRATION FORM

DEADLINE IS AUGUST 11, 2010

 

PARTICIPANT’S AGE IS AS OF OCTOBER 1, 2010

 

1. (    ) 5-year old Introductory Soccer Program - $15.00 registration fee*

 

2. (    ) Mighty Mite Soccer (boys & girls; ages 6 & 7) - $15.00 registration fee*

 

3. (    ) Junior Soccer (boys & girls; ages 8, 9 & 10) - $25.00 registration fee*

 

4. (    ) Senior Girls Soccer (Ages 11, 12 & 13) - $25.00 registration fee*

 

5. (    ) Senior Boys Soccer (Ages 11, 12 & 13) - $25.00 registration fee*

*Take $5.00 off registration fee for second participant in the same household.*

 

For the programs listed above, please indicate which area you would like your child based in.

(       ) Mountain View     (      ) Glasgow-Natural Bridge      (      ) Fairfield      (      ) Lexington       (       ) Effinger

 

FEES:  The RARO Board of Directors and Staff do not wish to exclude anyone from participating due to economic constraints.  Please contact the RARO office at 463-9525 should you have any questions regarding economic constraints. Buena Vista residents are welcome to participate in RARO-sponsored programs.  However, because BV residents do not reside within the jurisdictions that fund RARO, they must pay double the regular registration fee.  Fees are payable at time of registration.  For ages 6-13, RARO shirts are required.  The shirt fee is $25.00 and are available at our office.

 

 

Player’s Information

Last Name:

First Name:

MI

Suffix

Nick Name:

 

Date of Birth (MM/DD/YYYY)

                           

Age as of October 1, 2010

                                                            

Mailing Address:

 

City:

State:

Zip Code:
                 

Player’s Information

Emergency Contact Name:

Emergency Contact Number:

 

   This is in case we would need to reach you in an emergency.  These numbers are only given out to our coaches.

Gender:

             (        ) Male      (          ) Female

Resident of:

   (         ) Rockbridge County  (         ) City of Lexington (         ) Buena Vista   (        ) Other

Name of School:

 

Physician’s Name:

Physician’s Telephone:

                                     

Does this player have any disabilities, handicaps, present injuries or limitations, allergies, heart conditions, history of any respiratory illness or any other significant medical condition (    ) Yes     (    ) No   If yes, please explain here:  

                                                                                                                                                                                                                                                                                                                                                                                
       

Mother/Guardian

Last Name:

 

First Name

MI

Suffix

Home Telephone:

                         

Business/Employer:

 

Work/Cell Telephone:

                        

Email Address:
             

Father/Guardian

Last Name:

 

First Name:

MI

Suffix

Home Telephone:

                          

Business/Employer:

 

Work/Cell Telephone:

                          

Email Address:
             

 

BE SURE ALL QUESTIONS, BOTH FRONT AND BACK ARE ANSWERED SO THERE IS NO DELAY IN PROCESSING THIS FORM.

OVER

 

 

NOTE: We stagger the start of each league.  You will be contacted either by a coach or the RARO office

 

PROGRAM PHILOSOPHY: I understand that the objective of the Rockbridge Area Recreation Organization (RARO) Program is to provide recreational opportunities that instill good citizenship, good sportsmanship, good will and good fun.  The RARO athletic programs consequently place primary emphasis on full participation, balanced teams, positive coaching and officiating, and having fun.  Competitive spirit is nurtured, but emphasis on winning will not overshadow the goal of providing a healthy, challenging and satisfying experience for all RARO participants.

 

MEDICAL: The coach or supervisor has my permission in an emergency, when I or my physician cannot be contacted, to arrange for a rescue squad to take my child to the emergency room at Stonewall Jackson Hospital at my expense.  I do hereby grant permission for my son or daughter to participate in the program checked on the front of the form and release RARO, the coaches or program supervisors from any liability for damages or injuries which might be incurred during the operation of this program.

                I understand that all RARO coaches are volunteers.  No RARO employee or volunteer, RARO or its sponsoring institutions; or any institution or agency whose facilities are used for RARO activities will be held responsible for any injury my child might sustain. If I have any doubts about my child’s physical condition, I assure RARO that he or she has been examined by a physician prior to the start of the program selected for my child.

 

SIGNATURE OF PARENT OR GUARDIAN                                                                    DATE                         .

 

NOTICE TO PARENTS OR GUARDIAN: RARO HAS NO MEDICAL INSURANCE COVERAGE OF ANY KIND ON YOUR CHILD WHILE HE OR SHE PARTICIPATES IN A RARO EVENT.  IT IS IMPORTANT THAT YOU HAVE COVERAGE AND REALIZE THERE IS THE POSSIBILITY OF INJURY IN ATHLETIC EVENTS.  THIS FORM MUST BE COMPLETED AND FILED BEFORE YOUR CHILD CAN PARTICIPATE IN ANY RARO PROGRAM.  COMPLETION OF THIS FORM SIGNIFIES YOUR CONSENT FOR YOUR CHILD TO PARTICIPATE AND ACKNOWLEDGES THAT RARO PROVIDES NO MEDICAL INSURANCE IN THE EVENT OF AN INJURY TO YOUR CHILD. 

NAME OF YOUR INSURANCE COMPANY                                                    .

 

THE COACH OR SUPERVISOR HAS MY PERMISSION TO CALL MY FAMILY PHYSICIAN IN AN EMERGENCY WHEN I CANNOT BE CONTACTED.  PHYSICIAN INFORMATION IS LISTED ON THE FRONT OF THIS FORM PARENT’S PLEASE INITIAL                   .

 

THE FORM AND REGISTRATION FEE MUST BE IN THE POSSESSION OF RARO BY THE DUE DATE.  IF NOT, YOUR CHILD WILL BE PLACED ON A WAITING LIST AND EVERY EFFORT WILL BE MADE TO PLACE YOUR CHILD ON A TEAM.  THANK YOU.

 

The RARO Board will entertain requests for age exceptions only at the following Board Meetings:

                                Spring/Summer sports at the March Board Meeting

                                Fall sports at the August Board Meeting

                                Winter  sports at the November Board Meeting

 

Parents: We need volunteer coaches.  This is a chance to make a positive difference in our community.  We have clinics for those who wish to coach, but don’t have the training.

Yes, ____ I would like to coach, Name                                                    .                    

 

MAIL TO ADDRESS ON FRONT OR DROP OFF AT OUR OFFICE. REMEMBER: Fee amount MUST be paid at time of registration to avoid any delays in processing your child’s form.

 

*******Yes, I would like to be added to the mailing list ______and/or mass email list_______.*******  You can also download registration forms and get updated information on our website at www.rarorec.org.

(If you are already on the lists, don’t mark)

 

FOR OFFICE USE ONLY.

 

Registration form received by:                                                 Date form received:___________________                          

 

Total fee amount received: $                                                                    Check #                                   Cash rec’d.   ______         

 

Fee received by:                                                                                       Date received: _______________________                        

                          RARO Staff Member sign

 

If fee is inclusive of another participant within the family, please list that child’s name (s) here:

 

           __________________                                 _____________________

Child’s name                                                           Fee amount