FALL RIVER YOUTH SOCCER ASSOCIATION
Fall 2008 Registration Form
(Children born between August 1, 1994 and July 31, 2004 are eligible)

Last Name: First Name: M/F:
Address: City: State: Zip:
Home Phone: Date:
Email: Player's Date Of Birth:
Mother's Name: Father's Name:
Medical Problems:
Person to Notify in Emergency: Phone:
Doctor to Notify in Emergency: Phone:

I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the USYSA, its affiliated organizations and sponsers. Recognizing the possibility of physical injury associated with soccer and in consideration for the USYSA accepting the registrant for its soccer programs and activities (the "Programs"), hereby release, discharge and/or otherwise indemnify the USYSA, its affiliated organizations and sponsers, their employees and associated personnel, including the owners of fields and facilities utilized for the registrant's participation in the programs and/or being transported to or from the same, which transportation I hereby authorize.

Name:_____________________________

Signature: _________________________

 

Consent for Medical Treatment (Minor)
As parent or legal guardian of the above-named player, I hereby give my 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.

Signature:__________________________

Address: ___________________________

City ______________ State: ____ Zip:____

Home Phone #: ______________________

Bus. Phone #: _______________________

Check here if you DO NOT want your name to be used on a database for commercial mailings:
Adult Volunteer Signup - Name: Phone:
The success of the league depends upon our volunteers. Please check as many boxes of interest if you would like to assist the league. Someone will contact you. We are particularly in need of coaches. Thank You.
Coach: Asst. Coach: Fund Raising: Publicity:
Field Mgmt: Referee: Div. Coordinator Officer: