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Blue Ridge Youth Soccer Association
     
                       
                       
                Male / Female      
First Name   Middle Initial   Last Name     Sex (circle one)      
                       
                       
                       
Street Address     City / Town Phone Number(s)   Date of Birth      
                       
                       
                       
Mother's Name     Father's Name   (or) Legal Guardian's Name      
                       
                       
                       
Years Played   Position Played   E-Mail Address     Playing Age (as of 7/31/06)      
                       
                         
Consent For Emergency Treatment      
                       
We the Parents of _____________________________ give permission for emergency medical treatment of our child for illness or accident.      
                       
Person to be notified other than parent in case of emergency ____________________ Phone # ___________      
                       
Does your child have any allergies or any special medical conditions that the coach needs to be aware of?      
____ NO          _____ Yes (give details)      
                       
                         
We hereby agree that the Soccer Association for Youth (SAY), it's 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 supervision of SAY and agree to indemnify and hold harmless SAY, it's members, coaches, officers or designates of any claim whatsoever.      
                       
Parent or Guardian Signature _______________________________ Date ______________        
                       
                         
  Shirt Size (circle) Youth Youth Youth Adult Adult Adult Adult      
      Small Medium Large Small Medium Large  X Large      
                         
                         
Volunteers needed for the following: (Please check one)      
                       
Coach _____   Asst. Coach _____   Referee _____        
                       
Team Parent _____   Field Maintenance _____ Fund Raising _____        
                       
Ad Book_____   Concession____   Team Parent Coordinator____      
                       
  Returned Check Fee $25.00   Refund Policy:  Child not rostered within 30 days    
          of a completed and submitted registration packet.    
          No Exceptions            
                       
  Team Location Preference:                
                         
  Montrose _________________ Blue Ridge ________________        
                       
  We will try to honor this request, however team sizes determine player location.  Thank you BRYS
                       
                       
                       
                       
                       
Copyright © 2005 Blue Ridge Youth Soccer