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U12-U19 Player Registration for Summer 2012

IMPORTANT
Complete this registration ONLY IF player has been selected for a 2012 summer team.
View U12-U18 team selections.
Questions about selection? Contact:
Viktor Adamcsek or Nicole Lee at nicoleandviktor@gmail.com

Payment Address:  St. Paul Blackhawks, 2136 Ford Pkwy, St. Paul, MN 55116

Part 1 — Player/Parent Information
PLAYER
New to Blackhawks? (required)
Full First Name (required)
Last Name (required)
Date of Birth (required)  
Birth Certificate on file? (required)
Age Group of team
player has been selected for (required)
Level of team
player has been selected for (required)
Gender (required)
Player - Email
Player - Cell Phone
Player - Jersey #
PARENT 1
First Name (required)
Last Name (required)
Email (required)
Phone 1 (required)
Phone 2
Address (required)
City (required)
Zip (required)
PARENT 2
First Name
Last Name
Email
Phone 1
Phone 2
Address
City
Zip

Part 2 — Payment Instructions

Information about club dues is available in the 2012 SUMMER PROGRAM PACKET.

Club dues are payable in three equal installments. Payment 1 is due September 1, 2011. Payment 2 is due November 1, 2011 and payment 3 is due January 1, 2012. You will receive an e-mail confirmation of your first payment received and reminders about your subsequent installments.

Send payments to:

St. Paul Blackhawks
2136 Ford Parkway 138
St. Paul, MN 55116

Questions about payment:  info@blackhawksoccer.org

Part 3 — Financial Assistance Application

Financial assistance is available to all players. If you DO NOT want to apply for financial assistance,
skip to Part 4 now. If you want to apply for financial assistance, answer the questions below and mail
completed FINANCIAL ASSISTANCE APPLICATION with supporting materials (tax forms or income verification forms) to:

Brad Cohen
1460 Raymond Avenue
Saint Paul, MN 55108

Do you plan to apply for financial assistance for the 2012 Summer soccer season?
Have you received financial assistance from Blackhawks in the past?
If you answered "Yes" to the previous question, indicate the amount of your past award.
Recipients of financial assistance are required to submit a first installment payment within two weeks of receiving their award announcement. Please indicate "yes" that you are aware of this policy.
Award amounts are communicated via e-mail and we will ask you confirm receipt of the e-mail announcement. Have you provided the organization with a valid e-mail address that you check regularly? Choosing No means we will communicate via telephone.
Do you need any assistance in completing the financial assistance application?

Questions about financial assistance:  info@blackhawksoccer.org

Part 4 — Volunteer

St. Paul Blackhawks relies on volunteers to help keep our organization running and provide our players with a quality soccer experience. We need your help. Please volunteer at a level that is comfortable for you.

     
     
     
   
   

Questions about volunteering:  jody@blackhawksoccer.org

Review, Print, Submit Registration Form

Review registration form to make sure information is accurate. Print out this page using your browser's print function. Keep for your records. Click "Submit Registration Form" to continue.

Questions about registration:  Janine Braman, janinebraman@comcast.net 651-308-2111