Roanoke-Benson Recreation Assoc.

P.O. Box 621

Roanoke, IL 61561

RBRA 2017 Spring Soccer Program

Dear Parents and Athletes,

This year we will have a spring soccer season for Pee-Wee only.

Soccer requires good foot skills, speed and endurance.

Start handling the ball and start running
In-House:
RBRA will offer an in-house soccer program this spring for 4 to 6 year olds. Practice
will begin the week of April 4th. Games will begin April 15th with the last game on
May 13th. Games for will be at Nursing home on Saturday mornings.

Please Return Registration Form and Payment to RBRA

Mail to: RBRA

PO Box 621
Roanoke, IL 61561

Please DO NOT return this registration form to the school.

SOCCER REGISTRATION CLOSED FOR IN-HOUSE PROGRAM April 1st

Board of Directors
Chad Martin, President; Jonathan Weber, Vice-President; Dawn Alford, Treasurer
Dirk Norman; Vince Hummel, Leslie Cargill, Jesse Martin; Brian Reifsteck, Norm Weldon
 RBRA 2017 Spring SOCCER REGISTRATION

First Name: __________________________ Last Name: ______________________________

Age on April 4th: _______ Birth Date: ____ / ____ / ____ Current Grade in School: _______

Address: ____________________ Phone: (Home)_____________________(cell)____________________

Circle Shirt Size: Youth: (6-8) (10-12) (14-16)

League Fee Childs age/grade Description of League & Commitment

____ Pee Wee $25 4, 5, or 6 yrs old Players are introduced to rules & concepts. Will play
Sat. mornings @ Nursing Home(south of Duplexes.

COACHES - Volunteers are needed to make this program a success for the kids, please get involved!

Name of Coach: _________________________ Ph#:____________________

Please mark the level of commitment you are willing to make!

______ Head Coach - Attend almost all of the practices/games and serve as a contact for the team.
______ Asst Coach - Attend most of the practices/games and fill in when head coach is not there.

Please pay cash or check payable to RBRA. This registration form and the fee are required prior to participation and
serves as a permission slip for each player to participate in the RBRA baseball program. All participants are
responsible for their own health insurance coverage. In case of an emergency, I give permission for my child to be
given any necessary medical attention by a qualified and licensed medical doctor.

Emergency contact: Name: _______________________ Phone: ____ - ______ or ____ - ______

Parent / Guardian Signature: _____________________ Date: _________ E-mail: ____________________Text Y N

SOCCER REGISTRATION CLOSED FOR IN-HOUSE PROGRAM April 1st.

Board of Directors
Chad Martin, President; Jonathan Weber, Vice-President; Dawn Alford, Treasurer
Dirk Norman; Vince Hummel, Leslie Cargill, Jesse Martin; Brian Reifsteck, Norm Weldon