BEAVER YOUTH
SOCCER ASSOCIATION
Fall 2010
Soccer Registration
Last
Name:__________________________First:______________________M.I.:______
M or F
Birthdate:______________Phone
#__________________Parents:___________________________
City:_________________________ State:
___________ ZIP Code:_____________
Height/Weight:________/________Shirt
Size: YS (6-8) YM (10-12) YL (14-16) AS
AM AL AXL
NOTE: COPY OF BIRTH CERTIFICATE IS NOW REQUIRED
You
are required to wear black shorts and black socks for games. If you are unable to make
it to a practice or a game, you are required to call your coach to let them
know.
Please list any information concerning the player's medical history (including allergies, medications being
taken, and physical impairments):
________________________________________________________________________________
First
Contact:________________________________________Phone#:_______________________
Second
Contact:______________________________________Phone#:_______________________
Please circle if you would like to volunteer to help with any of the following:
Coach Asst.Coach Concession Stand Team Parent (organizing snacks for after games, etc.)
CONSENT FOR MEDICAL TREATMENT
As the parent or legal guardian of the above player, I hereby give consent for emergency medical care prescribed by a duly-licensed doctor of medicine or doctor of dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well being of my dependent.
Parent/Guardian:_________________________________Phone#:______________________
I, Parent/Guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the
USYSA, and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration of the USYSA accepting the registrant for it's soccer programs and activities (the programs), I hereby release, discharge, and/or otherwise indemnify the USYSA, it's affiliated organizations and sponsors, their employees and associated personnel, including the owners of
the fields and facilities utilized for the programs against any claim by or on behalf of the registrant as a
result of the registrant's participation in the programs and/or being transported to or from the same which
transportation I hereby authorize.
Parent/Guardian:___________________________
A non-refundable registration
fee of $40 is due with this completed form by August 2nd, 2010. Sibling discount applies after first child: 1st child $40.00, 2nd child $35.00, 3rd child $30.00 etc. Late registrations
will be accepted with an additional $5 fee until August 9th, 2010.
No registrations will be accepted beyond this date.
Make check or M.O. payable to: -- BEAVER YOUTH SOCCER ASSOC. -- P.O. Box 2792 -- East Liverpool, OH 43920