GYSA FALL 2010 REGISTRATION

Last Name:First Name:

A copy of the Birth Certificate must be sent in with your payment if your child was not previously registered.

Date of Birth: Male/Female: Male Female

E-Mail:Phone Number:

Grade: PRE K KINDERGARTEN 1ST 2ND 3RD 4TH 5TH 6TH 7TH 8TH HIGH SCHOOL School: ALTAMONT GUILDERLAND ELEMENTARY LYNNWOOD PINE BUSH WESTMERE FMS ST MADELEINE SOPHIE CHRIST THE KING HOME SCHOOL GHS OTHER

Mother or Guardian:Phone Number- if different:

Father or Guardian: Phone Number- if different:

Address: Town    ,NY        Zip Code

Each parent is expected to contribute to the all volunteer league.

Please select √ as many as you can.

TEAM AND LEAGUE ACTIVITIES

Coach:                     

Assistant Coach:  

Team Parent:        

Equipment Prep:   August 21 time TBA

Field Prep:            August 28 time TBA

If a parent is unable to contribute time to any of the above, a monetary contribution would be appreciated.

BUDDY

You may request to play on the same team as one friend or sibling if that person is in the same division. In order to be "buddied", both forms must contain the corresponding buddy's name.

Buddy last name:

Buddy first name:

LEAGUE REGISTRATION FEES

GYSA offers reduced cost registrations for any family with financial need. Just speak with any board member. The program maintains used cleats, shirts and shin guards for anyone who would like them.

Registration  Fee $35.00 (Family (3+) registration max $75.00)

Registration Fee before 6/30/10 $25.00 SAVE $10.00!                                                     

Registration Fee after 7/21/10 including late fee $45.00 (max $110.00)                  

GYSA Shirt $18.00 (if a new one is needed) Shirts may be picked up at the field during the first two weeks of the season. All sizes available.

Donation $  (Your donation would be greatly appreciated for equipment or the DiCaprio Park fund.)

MAKE CHECKS PAYABLE TO :GUILDERLAND YOUTH SOCCER ASSOCIATION

                                                            PO BOX 250 GUILDERLAND NY 12084

Medical Condition

Indicate player's special medical condition(s). This is mandatory. If no such condition, write "none"

Medical:

I UNDERSTAND THAT SOCCER IS A CONTACT SPORT AND THAT ALTHOUGH EFFORTS WILL BE MADE TO PROVIDE SAFE AND ORDERLY PRACTICE AND GAME CONDITIONS, THERE WILL ALWAYS REMAIN A CHANCE OF SERIOUS INJURY. RECOGNIZING THAT SUCH RISKS EXIST, I GIVE MY PERMISSION FOR MY CHILD TO PARTICIPATE IN THIS ACTIVITY. I ALSO AGREE TO RELEASE GUILDERLAND YOUTH SOCCER ASSOCIATION INC., ITS PLAYERS, COACHES, OFFICIALS, GUILDERLAND SCHOOL DISTRICT. AND THE TOWN OF GUILDERLAND OF ALL LIABILITY THAT MAY ARISE.

Child's Name:           

Parent or Guardian's Name:   

The submission of this form and remittance of payment will constitute acceptance of these terms.

 

Comments:Type comments here.

Copyright © 2003 GYSA. All rights reserved.
Revised: 07/08/10