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         

 

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                                    

 

 

-----------------------------------------------------------------------Cut here ----------------------------------------------------------------------------------------

YOUTHTOWNE ATHLETICS – West Allegheny Spring/Fall Soccer

Participant Permission and Release Form

 

______________________________________, _______________________, ________,

(Player’s Last Name)                                                 (First Name)                           (MI)

____________________________________________________      Male   /   Female

(Street Address)                                                                                      (Circle one)

________________________________, ____________________, _________________

(City)                                                              (State)                           (Zip Code)

            ____/____/____          ______-______-________

            (Date of Birth)                        (Parent Telephone #)

________________________  _________________________  _____________________

(Team Name)                            (Coach’s Name)                         (Coach’s phone)

 

PERMISSION AND PERMISSION TO TREAT

I/We, the undersigned Parent(s) or Guardian(s) of (print name of child on the following line)________________________________________________do hereby give permission for my/our child to practice and play soccer at the Youthtowne fields located on Youthtowne Drive in Clinton, PA 15026.  We also give permission for the individual(s) acting as guardian and in the best interest of my/our child, to treat my/our child, or to find treatment for my/our child, if medical attention is needed.

       

            _________________________           __________________________________

               (Date)                                                (Signature of Mother/Father/Guardian)

 

HOLD HARMLESS AND INDEMNIFICATION

In consideration of the agreement of The Maronda Foundation to allow my child to participate in soccer at Youthtowne, and INTENDING TO BE LEGALLY BOUND HEREBY, I agree to indemnify and hold harmless THE MARONDA FOUNDATION, and its employees and legal representatives, against any loss from any and all claims, demands and actions at law or in equity that may hereafter at any time be brought by my child, or anyone acting on his/her behalf, for the purpose of enforcing a claim for damages because of injury (including death) to my child as a result of, or in any way related to his/her participation in this activity.

 

I/WE agree that in case of injury to our/my child, I/We will apply our hospitalization and/or accident insurance toward the payment of the expenses incurred and will not look to The Maronda Foundation, or to its employees and legal representatives for the payment of any medical costs or injury related costs.

 

Furthermore, we have read and agree to follow the paper entitled “Rules and Regulations for Groups Using Youthtowne Athletic Fields.”

 

IN WITNESS WHEREOF, I/WE execute this Hold Harmless and Indemnification Agreement this ________ Day of ___________________, 20__.

 

                                                 ______________________________________________

                                                            (Signature of Mother/Father/Guardian)