Player's Information:
Mail to:
USAYSO,
11600 Manchaca Road #101
Austin, Texas 78748
Include a copy of the player's birth certificate
Player Registration Form
Fall 2012 Season
Please complete the information below :
Name: First Last
Address: Street,City, & Zip
Date of Birth:
School:
Gender:
Parent /Guardian Name:
Home Phone:
Cell Phone:
Email:
Occupation:
Employer:
Parent /Guardian Name:
Home Phone:
Cell Phone:
Email:
Occupation:
Employer:
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 Copa FC 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 Copa FC AND WE AGREE TO INDEMNIFY AND TO HOLD HARMLESS Copa FC, ITS MEMBERS, COACHES, OFFICERS OR DESIGNATES OF ANY KIND FROM ANY CLAIM WHATSOEVER.
Parental Support
Copa FC is a organization run mostly by volunteers. Each team, as well as the organization as a whole, requires adult participation. Please indicated below how you will contribute.
Comments:
Players Uniforms Fee $75.00
Payment Method
Player Age Group
Credit Card #
Exp. Date:
V-Code:
Check #
Amount Due:
Registration Fee:
Uniform Fee:
Registration Fee: $400.00 per season
Seasons Played, Prior Team, &Prior Coach:
