Spring 2015 Youth Soccer Registration Form Winter Haven Youth ...
Receipt #: ____________________
U5 –U18
Spring 2015 Youth Soccer Registration Form Winter Haven Youth Soccer Association
Office: (863) 965-0809 www.WHYSA.com [email protected] PLEASE PRINT LEGIBLY
Player’s First Name: _________________________________ M.I.:______ Last Name:______________________________ Street Address: _____________________________________ City: ________________________ Zip: _________________ Age: _________ Birth Date: ___________ Gender: ___________ Grade in School: ___________ Father’s Name: ______________________________________ Mother’s Name: ___________________________________ Home Ph.: _____________________ Cell: ____________________ Primary E-Mail: ________________________________ Have you participated in any soccer program in the past? Yes No
Age Group & Club: ______________
TEAM PLACEMENT: If you would like to play with a specific player and/or coach please complete the following: Player Name: _____________________________________ Coach Name: __________________________________ Please note: while we cannot guarantee every request will be honored, we will make every opportunity to honor your request based on compatible ages of the players requested, that the coach is actually coaching in the Spring, and has authorized your child to be on their team.
Shirt Size: YXS / YS / YM / YL / AS / AM /A L / AXL WHYSA is an all-volunteer league that is dependent on parents volunteering to coach. Please indicate below if you would be willing to help coach a team.
Player Registration Fees – Spring 2015
Yes
No Mail to: WHYSA Attn: Registration P O Box 1905 Winter Haven, FL 33883
* $5.00 Sibling Discount Registration Fee
$60.00* – Early Registration Fee (postmarked or paid at fields before 3/16/15) $70.00* – Spring 2015 Late Registration (postmarked or paid at fields after 3/16/15) Applications received after 3/16/15 will be reviewed and accepted based on availability
Calendar January 15th – Registration Begins April 11th – First Game May 16th – Last Game Day ***Office Use Only***
Date Received: __________ Amount Received:___________ Cash: _______ Check: ______ Check Number: ___________ Received By: ______________________________________ Notes: _____________________________________________
Permission to Play / Hold Harmless WHYSA WILL NOT ALLOW PLAYERS TO BE REGISTERED TO A TEAM WHOSE AGE GROUP EXCEEDS THE PLAYER'S NORMAL AGE. It is FYSA's policy that all players compete at a level they are capable of both physically and developmentally. INSURANCE NOTICE: All injuries must be reported within 30 days of the date of the injury. INFORMED CONSENT: I, the parent/guardian of the registrant, agree that we will abide by the rules of Winter Haven Youth Soccer Association, Inc. the state association (FYSA) and all its affiliated organizations. My/our child wishes to participate in soccer during the season of this registration. I/we realize risks are involved in my/our child’s participation. I/we understand that the risk to my/our child includes full range of injuries from minor to severe, and the result could be death, paralysis, or other serious, permanent disability. I/we accept this risk as a condition of my/our child’s participation.
__________________________________________________ __________________________________________________ __________________________________________________
I give my permission to have my child’s photo utilized for website or advertising for WHYSA exclusively. No photos will be sold. This is for recreation/recognition purposes only. Signature: _________________________________________ Date: _____________________
U5 –U18
Spring 2015 Youth Soccer Registration Form Winter Haven Youth Soccer Association
Office: (863) 965-0809 www.WHYSA.com [email protected] PLEASE PRINT LEGIBLY
Player’s First Name: _________________________________ M.I.:______ Last Name:______________________________ Street Address: _____________________________________ City: ________________________ Zip: _________________ Age: _________ Birth Date: ___________ Gender: ___________ Grade in School: ___________ Father’s Name: ______________________________________ Mother’s Name: ___________________________________ Home Ph.: _____________________ Cell: ____________________ Primary E-Mail: ________________________________ Have you participated in any soccer program in the past? Yes No
Age Group & Club: ______________
TEAM PLACEMENT: If you would like to play with a specific player and/or coach please complete the following: Player Name: _____________________________________ Coach Name: __________________________________ Please note: while we cannot guarantee every request will be honored, we will make every opportunity to honor your request based on compatible ages of the players requested, that the coach is actually coaching in the Spring, and has authorized your child to be on their team.
Shirt Size: YXS / YS / YM / YL / AS / AM /A L / AXL WHYSA is an all-volunteer league that is dependent on parents volunteering to coach. Please indicate below if you would be willing to help coach a team.
Player Registration Fees – Spring 2015
Yes
No Mail to: WHYSA Attn: Registration P O Box 1905 Winter Haven, FL 33883
* $5.00 Sibling Discount Registration Fee
$60.00* – Early Registration Fee (postmarked or paid at fields before 3/16/15) $70.00* – Spring 2015 Late Registration (postmarked or paid at fields after 3/16/15) Applications received after 3/16/15 will be reviewed and accepted based on availability
Calendar January 15th – Registration Begins April 11th – First Game May 16th – Last Game Day ***Office Use Only***
Date Received: __________ Amount Received:___________ Cash: _______ Check: ______ Check Number: ___________ Received By: ______________________________________ Notes: _____________________________________________
Permission to Play / Hold Harmless WHYSA WILL NOT ALLOW PLAYERS TO BE REGISTERED TO A TEAM WHOSE AGE GROUP EXCEEDS THE PLAYER'S NORMAL AGE. It is FYSA's policy that all players compete at a level they are capable of both physically and developmentally. INSURANCE NOTICE: All injuries must be reported within 30 days of the date of the injury. INFORMED CONSENT: I, the parent/guardian of the registrant, agree that we will abide by the rules of Winter Haven Youth Soccer Association, Inc. the state association (FYSA) and all its affiliated organizations. My/our child wishes to participate in soccer during the season of this registration. I/we realize risks are involved in my/our child’s participation. I/we understand that the risk to my/our child includes full range of injuries from minor to severe, and the result could be death, paralysis, or other serious, permanent disability. I/we accept this risk as a condition of my/our child’s participation.
__________________________________________________ __________________________________________________ __________________________________________________
I give my permission to have my child’s photo utilized for website or advertising for WHYSA exclusively. No photos will be sold. This is for recreation/recognition purposes only. Signature: _________________________________________ Date: _____________________
