Author: HP Authorized Customer

United South Austin Youth Soccer Organization

Registration Dates
Dec. 1, 2006—Feb. 3,2007
www.usayso.org

Mail to: USAYSO, 12015 Manchaca Road, Austin Texas 78748
Or Fax: 512/280-0281
Include a copy of the player’s birth certificate

Player Registration Form

Please Print

USAYSO —2007 Spring

Player’s Information:

Name:

Last:	First:	Middle:

Address:	City:	Zip:

School:	Date of Birth:	Gender: Male Female

Parent / Guardian :
Name :
Home Phone :
Work Phone :
Cell Phone :
Email :
Occupation :
Employer :

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 :

Parental Support
USAYSO 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.

Coach	Assistant Coach	Team Parent	Fund Raising	Donation
Concessions	News Letter	Field Work	Other Skills

Player	U-5 Coed	U-6 Coed		Circle	Age Group
Age	U-7 Girls	U-8 Girls	U-9 Girls	U-10 Girls	U-11 Girls	U-12 Girls	U-13 Girls	U-14 Girls	U-16 Girls
Group	U-7 Boys	U-8 Boys	U-9 Boys	U-10 Boys	U-11 Boys	U-12 Boys	U-13 Boys	U-14 Boys	U-16 Boys

U-5—U-6 $45.00	U-7—U-8 $55.00	U-9—U16 $65.00

Check # _______	Amount Paid:________

PLAYER UNIFORM FEE : $30.00

CC Number#__________________________ Exp. Date:__________

Credit Card	Check	Money Order	Cash

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. PARENT OR GAURDIAN SIGNATURE ______________________________

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. PARENT OR GAURDIAN SIGNATURE ______________________________Date__________________

Player Registrtion Form