AYSO REGION 1455 PLAYERSHIP APPLICATION

Information provided for the player should be for the upcoming season.

    Player Information:

    Player First Name:
    Player Last Name:
    Player Date of Birth:
    Grade:
    Age:

    Address:

    City:
    Zip Code:

    Gender:
    MF

    Parent/Guardian Information:

    Parent First Name:
    Parent Last Name:
    Work Phone:
    Home Phone:

    Address:

    City:
    Zip Code:

    Email Address:

    How many adults/minors are living in the household:

    Financial Background

    Is your child receiving/eligible for school lunches/meals?
    YesNo

    Annual Family Gross Income:

    Region Information

    You are applying for a Scholarship to play in Ladera Ranch AYSO, Region 1455:
    YesNo

    I understand that all non-refundable fees, transaction fees, and minimal league contribution (i.e National Player fees, uniforms) are not covered by applying to this Player Scholarship Program.
    YesNo

    If you answered "No" to the above question, please explain why.

    For what program are you applying a Scholarship for?
    FallSpring

    Additional Information

    Please provide us some information about your financial or other situation that will assist us:

    Have you received a Playership for this Player from AYSO in the past?
    YesNo

    Parent/Guardian Signature

    I have answered the above questions to the best of my ability. I have been honest about the family's situation. Type your FULL NAME as a digital signature.