2012 Bi-County Soccer Callout
For any child ages 4-15, before August 1, 2012, interested in playing soccer for the 2012 season; there will be a call out on
March 27th 5:30-7 pm at the Moose in Attica, March 29th 5:30-7 pm at the Williamsport American Legion, March 31st 10am-
noon at the Community Building in West Lebanon, April 2nd 5:30-7 pm at the Fire Station in Hillsboro, and April 4th 5:30-7 at
the Williamsport American Legion. If you can’t make it to a sign up, you may mail your registration and check to: Bi-County
Soccer P.O. Box 242 Attica, IN 47918. Registration can also be done at www.bicountysoccer.com using a credit or debit card.
Board members can be contacted with any questions.
Board members include:
Amy Matillo 765-427-3102 Beth or Chris Erwin 765-585-6477/765-585-0765
Erick Shamp 765-299-5412 Dyke or Shelia Rothenberger 765-893-4018
Amanda Dowers 765-299-2801 Jackie Cooper 765-585-8316
Matt/Jay Estes 765-798-2940/765-585-5249 Brad Summers 765-585-2108
The cost for entering is $15 per child, a form is required for each child. Please make checks payable to: Bi-County Soccer.
Anyone signing up after June 1, 2012 will be subjected to a $10 late fee and will not have a shirt by the first game. NO
REFUNDS, NO EXCEPTIONS!! This is a Bi-County Soccer League so children will be combined from all schools. We will make
every effort to place your child on a team from your area, but we make no promises that your child will be placed on a specific
team. If there is a coach you prefer, please place the name on the line below, if that coach has openings, your child may be
placed on that team.
Name:______________________________________________________Birthdate:_________________Age:_______
Address:____________________________________________________ Phone Number:_______________________
School:________________________________________ Parent’s Name:____________________________________
*Please inform a board member if there is anything specific we should know about your child (allergies, learning
styles, etc.)
Shirt Size for child playing:
_____ child extra small (2-4) _____adult small Age group signing up: 4-6______
_____child small (6-8) _____ adult medium 6-10______
_____child medium (10-12) _____adult large 10-15______
_____child large (14-16) _____adult x-large
______My child participates in other sports such as football, volleyball, cross country, etc that may interfere with
attendance at some games (this won’t affect team placement or playing time, just lets us know if a team has too
many players that may have conflicts that we need to place extra players on that team).
Family member shirts (these shirts are $12 each and must be paid for when ordering, please indicate a size and
what you would like printed on the back):
Child x-small_____ child small_____ child medium_____ child large_____ adult small_____ adult medium_____
Adult large_____ adult x-large_____ adult 2xl_____ adult 3xl_____ adult 4xl_____ (not all colors are available in
the 3xl and 4xl)
On the back I would like (example: Tristan’s Mom with child’s number or Megan’s Dad with the child’s number):
_____________________________________________________________________________________________________
___________________________________________________________________________________________
Please indicate if your child needs to be on a certain coach’s team or another child’s team. (Please note, this is
not a guarantee and will only occur if that team has openings.) Please put the full names of the other child.
______________________________________________________________________________________________
If you are interested in any of the following please check:
Coach_____ Asst. coach_____ Referee_____ Sponsoring a team_____ Board Member_____
By signing this paper you indicate understanding that Bi-County Soccer does not provide insurance for injuries to
players. I also understand that by participating in this league, my child’s picture may appear on the Bi-County
Soccer website www.bicountysoccer.com Child cannot play without a signature below!
_________________________________________________________Date_____________________________
Updated 2/23/2012