DEADLINE
FOR Spring REGISTRATION IS
January
10th!!!
Registration Fee: $40
($35 each additional child)
MAIL COMPLETED, SIGNED FORM WITH CHECK TO:
SSYSA
1055
HILLTOP DRIVE
GERMANTON,
NC 27019
SSYSA Spring 2003 SOCCER
SIGN-UPS
DEADLINE FOR
Spring
SIGN-UPS IS January 10th!!!!!!
No Refunds!!!!
COMPLETE
THE FOLLOWING INFORMATION (please print):
Name:
___________________________
Male _______� Female ____________
Birthdate:
_______________________
No. of Yrs. Played:
______________
Social Sec No: __________________
Phone:
__________________________
Address:_________________________
___________________________________
Parents:__________________________
Name as it should appear on
trophy:
Special
Needs:____________________
____________________________________
_________________________________
_________________________________
UNIFORM
SIZE:
Shirt Size (Circle ONE ONLY!!)
Adult�� S��������� M�������� L
Youth� S��������� M�������� L
Short Size (Circle ONE ONLY!!)
Adult�� S��������� M�������� L
Youth S��������� M�������� L
Having been informed of the organization of the SOUTHEASTERN STOKES YOUTH SOCCER ASSOCIATION to provide supported soccer games for the children, I /we the parents of the so named candidate do hereby give my/out approval to his/her participation in any and all activities.� I /we understand the nature of the insurance coverage provided through the registration fee.� However, I/we do assume all additional responsibility for hazards incurred in the conduct of the activities, transportation to and from activities, and I/we do further hereby release, absolve, indemnify, and hold harmless the SOUTHEASTERN STOKES YOUTH SOCCER ASSOCIATION, and also the others listed hereafter:� Organizers, Officers, Sponsors, Land Owners permitting use of their land for� soccer activities: any and all of them.� I/we also agree to furnish a CERTIFICATE OF BIRTH if requested by the SOUTHEASTERN YOUTH SOCCER ASSOCIATION.� IN CASE OF INJURY TO MY/OUR CHILD, I/WE WAIVE ALL CLAIMS AGAINST THE ORGANIZERS, SPONSORS, COACHES, OR REFEREES APPOINTED BY THEM.
PARENT SIGNATURE:__________________
PLEASE
KEEP IN MIND THAT ALL COACHES ARE VOLUNTEERS, SO PLEASE SHOW RESPECT, COURTESY,
AND NO VERBAL ABUSE!!
We are
always needing family members to step up and help with our soccer
programs.� If you are interested in any
of these positions, please indicate below:
____ Coach
____ Asst.
Coach
____ Team
Parent
____
Referee
If you
feel you do not know enough about soccer, we hold a coaches clinic each season
prior to the start of the games.
MAIL COMPLETED FORM,
WITH PARENT SIGNATURE AND CHECK TO:�
SSYSA, 1055 Hilltop Drive, Germanton, NC 27019.
FOR MORE INFORMATION,
YOU MAY CONTACT:
Paul
& Rebecca Mays����� 591-3207
Jackie
Martin������������������� 591-3279
Mike
& Bonnie Anthony� 593-9425
Mary
Lou Greene������������ 591-3222