Riverhead Police Athletic League

210 Howell Avenue, Riverhead, NY 11901

Juvenile Aid Bureau / PAL Office
David J. Hegermiller, Chief of Police
631-727-4500 x273

PAL SOCCER 2018 Registration

in conjunction with East End Football Club
Registration begins June 18, 2018 – Deadline: July 26, 2018
Games on SUNDAYS – September 16 – November 4, 2018 (NO Game 10/7/18)
A coed soccer program for boys and girls ages 4 – 12 by November 4, 2018.
7 SUNDAY Games @ Stotzky Park beginning Sunday, September 16.
6 Training Sessions led by certified trainers – Note day /time below.
NOTE: In the event of cancellation, every effort will be made to reschedule games and or training. However, if rescheduling is not possible fees will not be refunded.
NOTE: Please advise trainer if training day /time does not work with your schedule, your child may be able to train on an alternate day at the
discretion of the trainer if within a close age group.

U5/6 Ages: 4,5,6 U7/8 Ages 7 & 8 U9/10 Ages 9 & 10 U11/12/13 Ages 11 & 12
Age as of - Nov. 4, 2018 Age as of - Nov. 4, 2018 Age as of - Nov. 4, 2018 Age as of - Nov. 4, 2018
Training @ Riley Avenue School 9/11 Training @ Riley Avenue School 9/12 Training @ Riley Avenue School 9/11 Training @ Riley Avenue School 9/12
Train Tuesday– 4:30-5:30 PM Train Wednesday – 4:30-5:45 PM Train Tuesday – 5:30-6:45 PM Train Wednesday – 5:45-7:00 PM
Games: SUNDAY – 9-9:50 AM Games: SUNDAY – 10-10:50 AM Games: SUNDAY 11-11:50 AM Games: SUNDAY 12-12:50 AM
$80 per player– Riverhead Resident or $90 per player– Non-Resident
Register in person with EXACT CASH or mail to address above.
Checks should be made payable to Riverhead PAL.
REGISTER ON LINE starting June 27, 2018 @ riverheadrecreation.com
*Child must be age 4-12 by November 4, 2018 *

Child’s Name:_________________________________ DOB:_________AGE:____ TEAM: : ☐U5/6 ☐U7/8 ☐U9/10 ☐U11 /12/ 13

Check School attending Fall 2018: ☐Aquebogue ☐Riley ☐Phillips ☐Pulaski ☐Roanoke ☐Other

PINNY SIZE: YOUTH: ☐ Sm/Med ☐Lg/XL or ADULT: ☐Sm/Med ☐Lg/XL

Child’s Name:__________________________________DOB:_________AGE:___ TEAM: ☐U5/6 ☐U7/8 ☐U9/10 ☐U11 /12/ 13

CIRCLE School attending Fall 2018: ☐Aquebogue ☐Riley ☐Phillips ☐Pulaski ☐Roanoke ☐Other

PINNY SIZE: YOUTH: ☐Sm/Med ☐Lg/XL or ADULT: ☐Sm/Med ☐ Lg/XL

PARENT NAME: ________________________________________________________________________________________

Street Address:____________________________________________________ Town: _____________________ Zip_______________

Home Phone:(______)____________________________________Cell Phone:(_______)_______________________________________

E Mail : ______________________________________________________@ ______________________________

All communication through email -- Please PRINT CLEARLY

I, the parent/guardian of the above named child/children, hereby give my consent for participation in the above activity and do claim that
he/she/they are in perfect physical condition to participate in said activity.
Furthermore, I, the parent/guardian of the above named candidate(s) for a position on a league team hereby give my approval to his/her/their
participation in all league activities during the current season. I assume all risks and hazards incidental to such participation including
transportation to and from the activities; and I do hereby waive, release, absolve, indemnify and agree to hold harmless the Riverhead Police
Athletic League associated organizations, the organizers, sponsors, supervisors, participants and persons transporting my/our
son(s)/daughter(s), except to the extent and in the amount covered by an accident or liability insurance.
________________________________ ___________________________________ _____________
Parent/Guardian Print name clearly Parent / Guardian Signature Date
PAL Use ONLY: Check / CASH Name:____________________________________________Date:______________/2018
Entered RP:____________/2018 Check / Receipt #______________ $_________________