Mail to:
USAYSO,
11600 Manchaca Road #101
Austin, Texas 78748
Include a copy of the player's birth certificate
Player Registration Form
Fall 2014
Please complete the information below :
Player's Information:
Name:
Address: Street,City, & Zip
Date of Birth:
Gender:
Parent /Guardian Name:
Home Phone:
Cell Phone:
Email:
Emergency Contact:
Relationship:
Home Phone:
Cell Phone:
Doctors Name:
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.WE HERE BY AGREE TO PAY ALL FEE’S AND PENALTIES FOR THIS SEASON.
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.
Seasons Played, Prior Team, &Prior Coach:
Comments:
Players Uniforms Fee $65 Academy
$80 Select
Player Age Group
Registration Fee
U9-U10 Academy $250
U11-U19 D2 $350
U11-U19 Super2 $450
U11-U19 D1 $600
Payment Method
Payment Method
Credit Card #
Exp. Date:
V-Code:
Check #
Amount Due:
Registration Fee:
Uniform Fee:
Credit Card #
Exp. Date:
V-Code:
Check #
Amount Due:
Registration Fee:
Uniform Fee:
