Upson Soccer Association

                                                          Registration Form

 

Player’s Name

Birthdate

Address

Male:  (   )

 

Female:  (   )

City

County

Zip Code

Home Phone

 

(          ) 

Parent’s Name:

Mother:

 

Father:

Cell Phone

(          )

 

(          )

Email Address

Any medical conditions that would affect your child’s participation?

Insurance Information

 

Company:

Insurance Information

 

Policy Number:

Shirt Size:  (circle one)

 

  YXS   YS       YM       YL      

  AS      AM       AL       AXL

Sock Size:  (circle one)

 

           S        M        L      

Payment:

 

Check #______                  Cash ________

Payment Amount:

 

  $________________

 

I hereby give approval for the participation of my child in any and all GSSA and affiliated associations or league activities and I assume all risk and hazards incident to such participation, including transportation to and from said activities, waive, release, absolve, indemnify and agree to hold harmless the GSSA, USA, Thomaston-Upson Recreation Department and affiliated association league , the organizers, supervisors, officers, directors, participants and persons or parents supervising or transporting participants to or from such activities from any claim, arising out of injury to my child – I understand that a player who registers with affiliated league is bound to that league for the entire seasonal year unless a transfer is required for extenuating circumstances.

 

The Thomaston-Upson Recreation Department would like to notify parents/guardians that photos of individual players or teams will be taken for our sponsors and promotional projects and may be placed on department website.

 

I/We, the parents of the above named child, hereby give my/our permission to the person in charge of the activity to take my/our child to the doctor or hospital in case of injury.  I/We understand I/We will be responsible for any and all cost incurred by emergency transportation or medical treatment provided.

 

I understand and agree.  (Required Parent Signature) __________________________ Date:___________

 

________ I choose not to participate in the Rec One Insurance.   

 

Volunteers:

 

USA depends on your participation.  99% of USA consists solely of volunteers.  Without these volunteers, children may be turned away, which could include your child.  We are especially in need of coaches and/or assistant coaches in the younger age groups.  With USA training, guidance, and support, coaching a USA team is not beyond your abilities.  Remember, without you, our volunteer, there is no USA.

 

I would like to: COACH _________   ASST COACH __________ AGE GROUP:   U6    U8    U10   U12

 

**** NO REFUNDS AFTER TEAMS ARE DRAFTED****