Transcript Include this form with check or money order made payable to HYSA ALL registrations need to include a copy of their.

Include this form with check or money order made payable to HYSA
ALL registrations need to include a copy of their birth certificate.
MAIL TO: HYSA, P.O. BOX 992, BUDA, TX 78610
OR Register online at www.haysyouthsoccer.org
SPRING
2015
PLEASE PRINT PLAYER INFORMATION
Last Name
First
Address
Middle
City
Home Phone
Zip
Player date of birth
Player’s Age Group – Circle Bracket
Gender M
Player’s Age Group – Circle Bracket
Division 4
U5 Coed
U6 Coed
U8 Boys/U8 Girls
U10 Coed
(8/1/09 to 7/31/10)
(8/1/08 to 7/31/09)
(8/1/06 to 7/31/08)
(8/1/04 to 7/31/06)
F
Division 3
Fee $80
Fee $95
Fee $110
Fee $115
Mother’s Name
Father’s Name
U12 Boys/U12 Girls
U14 Boys/U14 Girls
U15 Boys/U15 Girls
U16 Boys/U16 Girls
U18 Boys/U18 Girls
Cell #
* Email
Cell #
* Email
(8/1/02 to 7/31/04)
(8/1/00 to 7/31/02)
(8/1/99 to 7/31/00)
(8/1/98 to 7/31/99)
(8/1/96 to 7/31/97)
Fee $130
Fee $130
Fee $130
Fee $130
Fee $130
* Email is a required field.
As the parent or legal guardian of the above named player, (1) I hereby give consent to emergency medical care prescribed by a duly
licensed doctor of medicine or doctor of dentistry. This care may be given under any condition necessary to preserve life, limb or well-being
of any dependent. (2) I agree that the registrant and I will abide by the rules of United States Youth Soccer (USYS) and its affiliated
organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for USYS accepting the
registrant for its soccer programs and activities (hereafter called the Program), I hereby release, discharge and/or otherwise indemnify the
USYS, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities
utilized for the Program, against any claims by/on behalf of the registrant as a result of the registrant’s participation in the Program, and/or
being transported to or from the same, which transportation I hereby authorize. AND (3) I acknowledge that HYSA has a ZERO TOLERANCE
Policy as stated in HYSA Section 3 rules. Comments and/or actions being perceived as negative or confrontational toward any player, coach,
referee, parent, or spectator WILL NOT BE TOLERATED.
HYSA COMPLEX is PRIVATE PROPERTY, and therefore HYSA reserves the right to ban any individual from the complex.
SIGNATURE of PARENT or LEGAL GUARDIAN:
DATE:
Parent/Legal Guardian signature REQUIRED to complete registration.
LIST ANY SPECIAL REQUEST, PLAYER MEDICAL PROHIBITIONS/LIMITATIONS BELOW:
Examples: Request to play in older age bracket; placement w/particular team/coach; asthma; etc.
PARENTAL SUPPORT – For HYSA to work, we need active participation from ALL families in the Program.
Each family is required to commit to 4 hrs (2 hrs - Facilities & 2 hrs – Concession) of volunteer work and a mandatory fundraiser per season or
choose to opt out and pay the opt out fee(s), due at time of registration. Please note, only one opt out fee is required per family (not per child).
**CIRCLE OPTION**
Facility Volunteer
OR
Opt Out $25 Concession Volunteer/Donate OR
Opt Out $25
Fundraising
OR
Opt Out $25
TEAM SUPPORT – Please circle any areas which you would be interested in assisting:
REFEREE *HEAD COACH *ASSISTANT COACH BOARD MEMBER
*counts towards volunteer hours
ALL COACHES MUST BE REGISTERED WITH KidSafe AND HAVE THEIR COACH LICENSE(S) ON FILE
**Registrations postmarked after deadline will be assessed a $15 Late Fee and subject to team availability on a first come, first serve basis **
Registration Received Date
Fee Due
OFFICIAL HYSA USE ONLY
Volunteer Opt Out
Total Due
Late Fees
Payment Received