PLAYER REGISTRATION FORM

FOR FALL 2008/SPRING 2009

Players Last Name First Name MI

Players Birthdate (MM/DD/YY)           Gender Male or Female (Circle One)

Street Address

       City State Zip

Home Phone E-mail

Father's Name: Wk Ph: Cell

Mother's Name: Wk Ph:    Cell

  Mother's Birthdate - MONTH AND DAY ONLY:

I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the USYSA, its organizations and sponsors, extending to and including the Warsaw Travel Soccer Club.  Recognizing the possibility of physical injury associated with soccer an 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, extending to and including the Warsaw Travel Soccer Club, their employees and associated personnel, including the owners of the fields and facilities utilized for the Programs, against any claim by or on the 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. 

Aug 1, 1999 - July 31, 2000

U9

Aug 1, 1998 - July 31, 1999 

U10

Aug 1, 1997 - July 31, 1998 

U11

Aug 1, 1996 - July 31, 1997

U12

Aug 1, 1995 - July 31, 1996 

U13

Aug 1, 1994 - July 31, 1995 

U14