Get Utah Youth Soccer Association Participant Registration Form

Utah Youth Soccer Association Participant Registration Form PLEASE PRINT FIRMLY AND LEGIBLY TO MAKE CLEAR MULTIPLE COPIES. PARENT/ GUARDIAN INFORMATION Name of the Parent/Guardian 1 Relationship to Child City Mailing Address Player Physical Address Home Phone Zip Work Phone Email Address Cell Phone Gender PLAYER INFORMATION Player s Name First/ MI /Last Elementary School Grade DOB MM/DD/YYYY Shirt Size / / Sock Size Emergency Contact Other than Parent Telephone Doctor to Notify in an Emergency List Medical Problem/Prohibition Player Has I WOULD LIKE TO HELP BY VOLUNTEERING Coach Assistant Coach Team Manager Team Parent Special Project Fund Raising Field Preparation Referee CONSENT FOR MEDICAL TREATMENT As parent or legal guardian of the above-named registrant I hereby give my 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 deemed necessary to preserve the life limb or well-being of the registrant. DATE PARTICIPATION RISK STATEMENT I the undersigned am a parent or legal guardian of the named minor. I fully understand that participating in the sport of soccer presents a risk for serious injury and death. In my capacity as parent or legal guardian I understand the risks and my responsibility to notify the other parent or legal guardians as well as the minor of the risks involved with sport participation* I have made a conscious decision to allow the named minor to play. I agree that my health and accident insurance will be the primary insurance to cover expenses for any such injury including rehabilitation* ADMINISTRATIVE USE ONLY Competition Recreation League/Club Number New Player Team Number Returning Player District Number Age-Group Birth Certificate Verified Registration Fees Received by Total Date Received CASH or CHECK THE GOVERNING BODY FOR AMATEUR YOUTH SOCCER IN UTAH Soccer Association USYSA and the United States Soccer Federation USSF. This care may be given under whatever conditions are deemed necessary to preserve the life limb or well-being of the registrant. DATE PARTICIPATION RISK STATEMENT I the undersigned am a parent or legal guardian of the named minor. DATE PARTICIPATION RISK STATEMENT I the undersigned am a parent or legal guardian of the named minor. I fully understand that participating in the sport of soccer presents a risk for serious injury and death. I fully understand that participating in the sport of soccer presents a risk for serious injury and death. In my capacity as parent or legal guardian I understand the risks and my responsibility to notify the other parent or legal guardians as well as the minor of the risks involved with sport participation* I have made a conscious decision to allow the named minor to play. In my capacity as parent or legal guardian I understand the risks and my responsibility to notify the other parent or legal guardians as well as the minor of the risks involved with sport participation* I have made a conscious decision to allow the named minor to play. I agree that my health and accident insurance will be the primary insurance to cover expenses for any such injury including rehabilitation* ADMINISTRATIVE USE ONLY Competition Recreation League/Club Number New Player Team Number Returning Player District Number Age-Group Birth Certificate Verified Registration Fees Received by Total Date Received CASH or CHECK THE GOVERNING BODY FOR AMATEUR YOUTH SOCCER IN UTAH Soccer Association USYSA and the United States Soccer Federation USSF.