Lil-Kickers Soccer Registration
Roxana Recreation Department

Questions? Call (618) 254-7485

Boys & Girls Ages 3, 4, and 5 (not yet in kindergarten)

Program Goals

Building self-esteem, basic skills, respect, positive competition, and sportsmanship.

Requirements

This is a family oriented program requiring all children registered to have a parent or guardian present to participate with the child.

Location

#2 Park Dr, Roxana, IL 62084
The field to the right of the Roxana Pool.

Equipment

All participants will receive a t-shirt with their name printed on the back. Shin guards are required, cleats are NOT required

When

This is a 4 week program, Saturdays, Sept 10, 17 24, and Oct 1
Session A: Saturdays 9:00 am - 9:45 am (class size 20 *)
Session B: Saturdays 9:50 am - 10:35 am (class size 20 *)
Session C: Saturdays 10:40 am - 11:25 am (class size 20 *)
Session D: Saturdays 11:30 am - 12:15 am (class size 20 *)
* Classes are decided on first come first serve basis.

Deadline and Fee

On or before Sept 3, 2021: $25

Close registrations

Registration Form

Session Preference (A,B,C,D) (required)

Player First Name (required)

Player Last Name (required)

Player Gender (required)

Player Birth Month (required)

Player Birth Day (required)

Player Birth Year (required)

Player Shirt Size (required)

Player School

Player Grade

Played Last Year?

Team Last Year

Parent First Name (required)

Parent Last Name (required)

Parent Phone (required)

Parent Email (required)

Parent Street (required)

Parent City (required)

Parent State (required)

Parent Zip (required)

Medical Conditions (required)

Emergency Contact Name (required)

Emergency Contact Relation (required)

Emergency Contact Phone (required)

Volunteer? (required)

Volunteer Name

Volunteer Phone

Terms and Conditions / Waivers
To continue, you must agree to all items below by checking each box.

I, the named or legal guardian of this child, do agree and abide by the Parents Code of Ethics

I do hereby consent and agree that the above named minor may participate in the Roxana Recreation/Tri-City program.

I acknowledge that there are certain risks of physical injury associated with my child’s participation in the above name program which may occur through no fault of any volunteer, participant, employee, or officer of the Tri-City Recreation League, Roxana Recreation and/or any other sponsors or party

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Lil-Kickers Soccer Registration Roxana Recreation Department