West Allegheny Youth Soccer Association

Player Registration Form

P.O. Box 540

Imperial, PA  15126

www.westasoccer.com

 

 

Player Name: First                                                         MI         Last                                                                 

           

Address:                                                                       City                              State                Zip                   

 

Phone #:                                                             Date of Birth:                                       Age:                           

 

Sex: Male _____ Female _____  # of Years Playing Soccer              Email:                                                             

 

U12 & U14 Travel Teams:  q Birth Certificate       q  Photo          q  Social Security #                                       

 

FEES

 

The registration fee is per playing session.(Fall and Spring being the only two playing sessions.)  Each session will consist of between 8-10 games plus, at least, 1 practice per week.  All fees are non-refundable.

 

            FIRST CHILD:                $35

            SECOND CHILD +:        $30

 

            GAME JERSEY:            $20 (First time players or replacement)   q Received

 

            JERSEY SIZES:            Youth:   q Medium          q Large

                                                Adult:    q Small              q    Medium         q   Large

 

CONSENT AND WAIVER

 

I recognize and understand that soccer is a sport involving risks not encountered in everyday play.  With this understanding, in consideration of West Allegheny Youth Soccer Association (WAYSA),  permitting my child to participate in the youth soccer program, I covenant and agree to indemnify and hold harmless and do release, requit and forever discharge WAYSA, its Board of Directors, coaches, referees and other such volunteers as are connected with WAYSA in any capacity, for any and all damages, claims, and/or liabilities arising out of any and all injury to or caused by my child.  With the knowledge and understanding of the foregoing, this is to certify that my child has my permission to play soccer in the WAYSA program.  Further, I hereby authorize any and all emergency medical treatment deemed necessary by a physician, nurse or paramedic.  A copy of this authorization shall be as effective as the original.

 

Parent/Guardian Signature:                                                                              Date:                                                    

 

VOLUNTEERS

(Soccer Experience Not Necessary)

 q Coach         q   Assistant Coach        q  General Volunteering (Registration, Picnic, etc.)

 Name of volunteer:________________________________________________

 

Total Received: $                       Check Number                Cash    Age Group