Player's Information:
Mail to:
USAYSO, 11600 Manchaca Road #101, Austin, Texas 78748
or Fax: 512/280-0281
Name:
Address: Street,City, & Zip
Date of Birth:
Gender:
Parent /Guardian Name:
Home Phone:
Cell Phone:
Email:
Emergency Contact:
Relationship:
Home Phone:
Cell Phone:
Doctors Name:
Phone:
Insurance Company:
Policy Holder's Name:
Phone:
Policy Number:
Consent for Medical Treatment
As a parent or legal guardian of the registrant, 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.
Consent for Play
WE HEREBY AGREE THAT THE SOCCER ASSOCIATION FOR YOUTH (SAY) ITS MEMBERS, COACHES OR OFFICERS SHALL NOT BE LIABLE FOR ANY INJURY OR LOSS WHICH MY CHILD MAY SUSTAIN WHILE PARTICIPATING IN ACTIVITIES OF ANY KIND WHETHER SPONSORED BY OR UNDER THE SUPERVISION OF SAY AND WE AGREE TO INDEMNIFY AND TO HOLD HARMLESS SAY, ITS MEMBERS, COACHES, OFFICERS OR DESIGNATES OF ANY KIND FROM ANY CLAIM WHATSOEVER.
Summer Camp
CAMP DATES
CAMP SESSION
Check #
Amount Due:
Registration Fee:
Any question concering dates or time feel free to call 512/563.2052
