Girl's Soccer

* indicates a required answer.

1. *

Students Name: (a registration form must be filled out for each student)

2. *

Parents Name:

3. *


4. *

Home Phone Number:


Cell Phone Number:

6. *

Email is required.


Additional Email or email address for student if different from parents:


Students Grade:

Use your Ctrl & Shift keys to select multiples.

Students Current Age:

10. *

Students Date of Birth (mm/dd/year):

11. *


12. *



Students Uniform jersey size:


Students Uniform shorts size:


How did you hear about the James River Eagles?


Would you consider your soccer skills to be: (choose one)


I certify that my child is home-educated and that we have read and agree to abide by the James River Home School Foundation's Player and Parent Code of Conduct. I also give JRHSF permission to use photographs taken of my child throughout the season to be used in publications related to the James River Eagles and the James River Home School Foundation.

 (1 required)
I accept See exception below

Please explain:

19. *

Emergency Contact Name:

20. *

Emergency Contact Phone Number

James River Eagles - Interscholastic Soccer 2015 Registration Prices:
Middle & High School Girls............... $150.00
We offer a 10% Sibling Discount for each player within a family!

Checks can be made payable to:  James River Eagles
and mailed with the required paperwork to:
James River Home School Foundation
3374 Medway Lane
Powhatan, Va 23139



You MUST provide a copy of the students birth certificate if it has not already been provided AND a copy of the current Virginia Notice of Intent to Home School Form or a copy of your religious exemption waiver. Please send a copy of both documents in with your payment or indicate if previously submitted:

1) Students birth certificate, and
2) Notice of Intent OR Religious Exemption

 (1 required)
Copy of birth certificate previously submitted. Copy of birth certificate will be provided.
Copy of religious exemption on file.

Don't forget to provide a copy of your current Virginia Notice of Intent Form or religious exemption and a copy of your child's birth certificate (unless already on file) with your payment.  Also please complete and sign the Required Medical Information and Release of Liability form and return it with your paperwork.