PLAYER FULL NAME * First Name Last Name GENDER * MALE FEMALE BIRTH DATE * MM DD YYYY NEW/RETURNING/TRANSFERED * NEW RETURNING TRANSFERED PLAYER IF RETURNING - RETURNING TEAM IF NEW - PREFERED EXISTING TEAM MEDICAL ALLERGIES * YES NO ALLERGIES CONCENT OF MEDICAL TREATMENT * As the parent or legal guardian of the above-named layer, 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 a YES NO MEDICAL WAIVER * Recognizing the possibility of injury or illness, and in consideration for US Youth Soccer and members of US Youth Soccer accepting my son/daughter as a player in the soccer programs and activities of US Youth Soccer and its members (the "Programs"), I consent to my son/daughter participating in the Programs. Further, I hereby release, discharge, and otherwise indemnify US Youth Soccer, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my player son/daughter as a result of my son's/daughter’s participation in the Programs and/or being transported to or from the Programs. I hereby authorize the transportation of my son/daughter to or from the Programs. My player son/daughter has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I have provided written notice, which is submitted in conjunction with this release and attached hereto, setting forth any specific issue, condition, or ailment, in addition to what is specified above, that my child has or that may impact my child's participation in the Programs. I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment. YES NO PARENTS FATHER/MOTHER * FATHER MOTHER PARENT NAME * First Name Last Name PHONE NUMBER * (###) ### #### FATHER/MOTHER FATHER MOTHER PARENT NAME 2 First Name Last Name PHONE NUMBER 2 (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * EMAIL TO SEND CLUB INFORMATION AND COACH ANNOUNCEMENT (PRACTICE/GAMES) CLUB REQUIREMENTS STYSA AGREEMENT * 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 sponsors. 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”), I hereby release, discharge and/or otherwise indemnify the USYSA, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. YES UNIFORM SIZE * UNIFORM SIZE SELECTION IS FINAL. BSYSC WILL ORDER UNIFORM BASED ON SELECTION. CORRECTION OF MISFIT WILL RESULT IN ADDITIONAL UNIFORM CHARGES. YOUTH X SMALL YOUTH SMALL YOUTH MEDIUM SMALL YOUTH LARGE ADULT SMALL ADULT MEDIUM ADULT LARGE ADULT X-LARGE BIRTH CERTIFICATE * I understand that my child's BIRTH CERTIFICATE is "REQUIRED" for age verification. Please upload document to GotSoccer players account or email a picture to Registrar@baytownsaints.org YES NO REGISTRATION * I understand if I am registering my player in the INCORRECT registration program (age bracket, level of play, or the player is a play-up), I am responsible for any additional fees that may be required in order to have my player assigned to the correct registration program. Failure to pay the required fees may result in my player NOT BEING ASSIGNED TO A TEAM. YES NO VOLUNTEERING VOLUNTEER * Would you like to volunteer for the organization? YES NO COACHING * Would you like to coach a team? BSYSC is an all volunteer organization. In the event that a Coach is not available for your player's team, would you like to be considered as a volunteer Coach? (Registration, a Criminal Background Check. and two (2) Required National On-Line Training Modules are required). YES NO REFEREE REFEREE * If your child/player is 10 years or older would she or he be interested in becoming a Youth Referee and earn extra money? BSYSC provides training and equipment cost refund (If requirements are met) YES NO FINANCIAL AID FINANCIAL AID * BSYSC Provides financial Aid for qualifying Players. Would you like to apply for financial Aid.? YES NO Thank you!
