Southeastern
Stokes Youth Soccer Association
Spring 2005 Sign-ups
Registration
fee: $50 ($45 for each additional child)
NO REFUNDS!!!
WE
DO NOT GUARANTEE ANY SPECIAL REQUESTS FOR SPECIFIC TEAMS/COACHES!
Mail completed registration
form to:�� SSYSA
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F Name: ___________��� MI: ___� L Name:� ________________���� SS #:� _____________________
Male:� ____� Female:� ____����� Birthdate: Month:___ Date:___ Year: 19___� No. of Yrs. Played_______
Street Address:� _________________________________City:
___________________�� Zip:________�
Mother�s Name:� ____________________� Mother�s Work/Cel Phone:� ________________________
Father�s Name:� ____________________��
Father�s Work/Cel Phone:���
________________________
Email Address:� ____________________________________Home
Phone:_______________________
NAME AS IT SHOULD APPEAR ON TROPHY:� _____________________________
Special Needs:� __________________________________________________________
Uniform Size:�
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Youth�����������������������
Adult
Shirt Size (Circle
ONE only!!):��� YS��� YM��� YL���������
AS��� AM���
Short Size (Circle
ONE only!!):��� YS��� YM��� YL��������
AS��� AM���
PLEASE READ & SIGN BELOW
� PLAYERS ARE NOT ALLOWED TO PRACTICE UNTIL THIS FORM IS SIGNED & SUBMITTED
TO SSYSA!!!
Having
been informed of the organization of Southeastern Stokes Youth Soccer Association
(SSYSA) to provide supported soccer games for the children, I/we the parents
of the so named candidate do hereby give my/our 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 SSYSA, and also the others listed hereafter:�
Organizers, Officers, Sponsors, Landowners permitting use of their
land for soccer activities:� any and all of them.� I/we also agree to furnish a birth certificate
if requested by SSYSA.� In case of
injury to my/our child, I/we waive all claims against the organizers, sponsors,
coaches or referees appointed by them.� Additionally, I/we give permission for our child�s
first name and last initial to be published on the SSYSA website along with
a photo of the child taken during team play, formal team photo, or award
recognition ceremony.
PARENT SIGNATURE:___________________________________����� (REQUIRED!!!)
I am interested in being a
coach_____, asst. coach ______, team parent ________.
For SSYSA Use
Only:
Date Paid:� ______________������� Rec�d by: ________________________ ��Reviewed by: _______________
�
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