Monroe County Youth Soccer League (MCYSL)
Spring Season 20132
MCYSL welcomes all vereran and new players this season.
Spring Season 20132
MCYSL welcomes all vereran and new players this season.
MCYSL GOAL POST
MONROE COUNTY YOUTH SOCCER LEAGUE
P.O. BOX 712 PETERSTOWN, WV 24963
Registration Form
Team Name_____________________________ Age Group_____________
(MCYSL use only) (MCYSL use only)
Players Name ________________________ DOB___________ M/F Circle
Address_______________________________________________________
Contact Person ______________________Phone Number______________
Fathers Name __________________________________________________
Address_______________________________________________________
Home Phone________________ Cell ____________¬-_Work_____________
Mothers Name__________________________________________________
Address_______________________________________________________Home Phone________________ Cell _____________Work _____________
Email Address__________________________________________________
Emergency Contact Person_______________________________________
(Other than Parent or Guardian)
Home Phone________________ Cell _____________Work _____________
Family Doctor _____________________________Phone # _____________
Primary Insurance Co.___________________________________________
Policy Number__________________________________________________
Allergies & Medical Disabilities ___________________________________
MCYSL operates only through the support of volunteers. MCYSL wants to continue offering the great sport of soccer to our children and community in a safe and clean environment. Please check the areas that you are willing to donate your support. If you feel you cannot obligate your support please make a donation of $20.00 per child playing soccer to MCYSL. Thank You!
Concession ______ Fundraising _____ Coach ______ Asst. Coach _____
Registration Fee ________Donation ________Socks/Shin guards_______
Check# _______ Cash _______Receipt Number __________________
Received By_______________________
MCYSL Registration Form Page-2
I received a copy of the MCYSL Code of Conduct and Rules. I agree that my child will abide by the rules established therein. I understand that adherence to these rules will determine the eligibility to participate in this activity of MCYSL. Noncompliance can result in dismissal from the league. I understand the game jersey belongs to MCYSL and there will be a $35.00 fee if not returned or damaged. Players will not receive a trophy until uniform is returned back to MCYSL.
Parent/Guardian Signature ______________________________________
Recognizing the possibility of physical injury associated with soccer and in consideration for USYSA/USSF and its affiliates accepting the registrant for its soccer programs and activities (the Programs) I hereby release, discharge and/or otherwise indemnify USYSA/USSF, 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’s participation in the Programs and/or being transported to or from the same, which transportation I here authorize. My child has received a physical examination by a physician and has been found physically capable of participating in the Programs.
Therefore I grant MCYSL permission to act as my surrogate for my child in the area of obtaining medical and dentistry care in the event of an emergency. I also assume financial responsibility for any such medical treatment for my child.
Parent/Guardian Signature_______________________________________
Subscribed & sworn to me this ______day of _________________ 20____
Notary public signature__________________________________________
My commission expires __________________
MONROE COUNTY YOUTH SOCCER LEAGUE
P.O. BOX 712 PETERSTOWN, WV 24963
Registration Form
Team Name_____________________________ Age Group_____________
(MCYSL use only) (MCYSL use only)
Players Name ________________________ DOB___________ M/F Circle
Address_______________________________________________________
Contact Person ______________________Phone Number______________
Fathers Name __________________________________________________
Address_______________________________________________________
Home Phone________________ Cell ____________¬-_Work_____________
Mothers Name__________________________________________________
Address_______________________________________________________Home Phone________________ Cell _____________Work _____________
Email Address__________________________________________________
Emergency Contact Person_______________________________________
(Other than Parent or Guardian)
Home Phone________________ Cell _____________Work _____________
Family Doctor _____________________________Phone # _____________
Primary Insurance Co.___________________________________________
Policy Number__________________________________________________
Allergies & Medical Disabilities ___________________________________
MCYSL operates only through the support of volunteers. MCYSL wants to continue offering the great sport of soccer to our children and community in a safe and clean environment. Please check the areas that you are willing to donate your support. If you feel you cannot obligate your support please make a donation of $20.00 per child playing soccer to MCYSL. Thank You!
Concession ______ Fundraising _____ Coach ______ Asst. Coach _____
Registration Fee ________Donation ________Socks/Shin guards_______
Check# _______ Cash _______Receipt Number __________________
Received By_______________________
MCYSL Registration Form Page-2
I received a copy of the MCYSL Code of Conduct and Rules. I agree that my child will abide by the rules established therein. I understand that adherence to these rules will determine the eligibility to participate in this activity of MCYSL. Noncompliance can result in dismissal from the league. I understand the game jersey belongs to MCYSL and there will be a $35.00 fee if not returned or damaged. Players will not receive a trophy until uniform is returned back to MCYSL.
Parent/Guardian Signature ______________________________________
Recognizing the possibility of physical injury associated with soccer and in consideration for USYSA/USSF and its affiliates accepting the registrant for its soccer programs and activities (the Programs) I hereby release, discharge and/or otherwise indemnify USYSA/USSF, 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’s participation in the Programs and/or being transported to or from the same, which transportation I here authorize. My child has received a physical examination by a physician and has been found physically capable of participating in the Programs.
Therefore I grant MCYSL permission to act as my surrogate for my child in the area of obtaining medical and dentistry care in the event of an emergency. I also assume financial responsibility for any such medical treatment for my child.
Parent/Guardian Signature_______________________________________
Subscribed & sworn to me this ______day of _________________ 20____
Notary public signature__________________________________________
My commission expires __________________