Player's Information:
Mail to:
USAYSO, 11600 Manchaca Rd #101
Austin, Texas 78748
Registration Form
Please complete the information below :
Name: Last, First
Address: Street,City, & Zip
Date of Birth:
Gender:
Parent /Guardian Name:
Home Phone:
Work Phone:
Cell Phone:
Email:
Occupation:
Employer:
Emergency Contact:
Relationship:
Home Phone:
Work Phone:
Cell Phone:
Doctors Name:
Address:
City / Zip:
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.
FEE: $100.00 weekly
Payment to be paid on the first day of camp.
Accepted method of payment is Cash or Check
Make payment payable to USA Youth
