PLAYER REGISTRATION FORM

	PLAYER INFORMATION First Name: * Last Name: * Player's Age: * Player's Birthdate: * Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Address: City: State: Zip: T-Shirt Size: * Youth S Youth M Youth L Adult S Adult M Adult L Adult XL BOYS / Age Group: Under 8 (08/01/01 to 07/31/02) Under 9 (08/01/00 to 07/31/01) Under 10 (08/01/99 to 07/31/00) Under 11 - U16 (08/01/93 to 07/31/99) GIRLS / Age Group: Under 8 (08/01/93 to 07/31/99) Under 9 (08/01/00 to 07/31/01) Under 10 (08/01/99 to 07/31/00) Under 11 - 16 (08/01/93 to 07/31/99) Is the player registered in the KYSC Fall season? Yes No If no, where is the player registered for Fall?   PARENT / GUARDIAN INFO First Name: * Last Name: * Phone (Day): Phone (Night): * Cell Ph: * Email: * GENERAL LIABILITY - I, the parents/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the USYSA, its affiliated organizations (such as KYSA) and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration by 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, their employees and associated personnel, including the owners of the fields and facilities utilized for the Programs, against any claim by or on 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. Electronic Signature: By clicking here, you agree with the conditions stated above and acknowledge that all information if correct. Date: CONSENT FOR MEDICAL TREATMENT (MINOR) - As the parent or legal guardian of the above-named player, 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. Electronic Signature: * By checking this box, you consent to the terms stated above for medical treatment. Date: PLEASE PRINT THIS FORM BEFORE PRESSING THE 'SUBMIT' BUTTON.     Under 8: 5:30 to 6:30pm Friday Nights at Katy Park Under 9 and Under 10: 6:30 to 7:30pm Friday Nights at Katy Park Under 11 - 16: 7:30 to 8:30pm Friday Nights at Katy Park