FOR LEAGUE
U.S. YOUTH SOCCER MEMBERSHIP FORM
USE ONLY
TRANSFER
NEW
REREGISTRA--
Season 2005/2006
TION
-
CHANGE/
I
I
CORRECTION
/
League
Age
Name
Group
U.S. Youth Soccer
Affiliated with
the United States Soccer Federation (USSF)
Affiliated with the Federation Internationale
de Football Association (FIFA)
Club/Team
Name(s)
(USE
4 B
63
CYSA
CODE
I.D. #
ONLY)
Class= 1 3, 4
Region
State
District
Team
League
Club
PLEASE PRINT FIRMLY AND LEGIBLY TO MAKE CLEAR MULTIPLE COPIES.
First
Last
Name
Name
Address
City
Player = P
Male = M
State
Zip Code
Area Code
Month
Year
Telephone Number
Day
Female = F
Coach = C
Birthdate
Father's Name
Bus.Phone
Occupation
Optional
E-Mail
Optional
Mother's Name
Bus.Phone
Occupation
Optional
E-Mail
Optional
List any medical problem or prohibition player has
Person to notify in emergency
Telephone
Doctor to notify in emergency
Telephone
Number prior
Last
Last
Date of
Team
20
seasons played
Last Season
League
Height
Grade
School
Weight
UNIFORM SIZE
I
I
Other
YOUTH
ADULT
Children
SHIRTS:
XSSMLXL
From Family
SHORTS:
XSSMLXL
XSSMLXL
Presently
XSSMLXL
XSSMLXL
SOCKS:
In League
PARENTAL SUPPORT
IMPORTANT
We ask for active participation of all parents in our program.
Check areas in which you would be willing to help.
I, the parent/guardian of the below-named player, a minor, or as a player over the age of 18, agree that I and the player
will abide by the rules and regulations of the U.S. Youth Soccer (USYS), and its affiliated organizations (USYS Parties), and the
California Youth Soccer Association, Inc. (CYSA) and its affiliated organizations (CYSA Parties). I, for myself and the player and
our respective heirs, administrators and successors, intending to be legally bound, hereby release and indemnity the USYS and
CYSA Parties, the owners and operators of the facilities used for the Programs, and their respective directors,
officers, employees, agents and representatives from and against all claims, liabilities, damages or causes of action
arising out of or in connection with the player's participation in the Programs including, without limitation, player's
transportation to/from any Program, which transportation is hereby authorized. I further grant the USYS and CYSA
Parties the right to use player's name, picture and/or likeness in printed, broadcast and other material concerning
the Programs provided such use is related to the player's status as a participant in the Programs.
Committee
Coach
Referee
Asst. Coach
Fund Raising
Team Manager
Clerical
Team Parent
Reporter
Special Projects
Newsletter
Field Preparation
Concessions
Board Member
Name
Donor
Publicity
Print Name of Parent/Guardian/Player Over 18 Years of Age
Signature
Other
Date
OFFICIAL USE ONLY
Picture Received
Yes
No
CONSENT FOR MEDICAL TREATMENT (MINOR)
As the parent or legal guardian of the above-named player or as a player over the
age of 18, 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 the life, limb or well-being of my dependent.
No
Birthdate Verified
Yes
Registration Fees:
Player Fee
$
Coach's Fee
Signature of Parent/Guardian/Player Over 18 Years of Age
$
Received By
x
Other
$
Date
Address
TOTAL $
State
City
Zip
CASH
Check No.
Phone: Home
Bus.
Form 1601 (01/04)
LEAGUE COPY
REDWOOD JUNIOR SOCCER LEAGUE
San Andreas Youth Soccer Organization (SAYSO)
02
03
01
CA
P
XSSMLXL
 
Click inside box and
then PULL DOWN to select