Fall Soccer Player Registration Form
Soccer Player Last Name: _____________________ First: __________________ MI: ____
Date of Birth: ___ /___ /_____ Gender: Boy / Girl September Grade: K 1st 2nd 3rd 4th 5th 6th
Shirt Size: SM (6-8) MED (10-12) LG (14-16) Adult SM School: ____________________
Parent/Guardian Name(s): ____________________________________________________
Mailing Address: ____________________________________________________________
Town: _____________________________ State: ______ Zip: ____________
Home Phone#: _____________________ Cell Phone #: _________________________
Email Address: ____________________________________________ (please print clearly)
Emergency Contact Name: ______________________________ Phone #: _____________
Release from Liability
I, the parent of the above registrant, agree that the registrant and I will abide by the rules of the USYSA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for Bennington Youth Soccer League (BYSL) accepting the registrant for its activities, I hereby release, discharge and/or otherwise indemnify the USYSA, its affiliated organizations and sponsors, their employees and volunteers, including the owners of fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as the result of the registrant’s participation in the programs and/or being transported to or from the same, which transportation I hereby authorize.
Consent for Medical Treatment
As the parent or legal guardian of the above named player, I hereby give my consent for coaches or board members of Bennington Youth Soccer League (BYSL) to act as my surrogate for my child in the area of obtaining medical treatment by a doctor of medicine or dentistry. I also assume financial responsibility for any medical treatment for my child.
Parents are reminded that coaches, board members and referees are volunteers, giving their time so that the kids can play. At no time should anyone be yelling at these volunteers. If there are concerns or questions about the program they should be addressed in an appropriate manner at an appropriate time. As a parent, I realize that my cooperation with this will ensure a positive experience for everyone.
Parent/Guardian Signature: ____________________________________ Date ____________
Parent Volunteers make BYSL possible for your kids.
If you are interested in helping out please complete a volunteer form.
Travel Teams (4th - 6th graders): $60 per player and $10 discount per additional child
K to 3rd graders: $50 per player and $10 discount per additional child (same family)
Register online or mail registration forms with payment (checks made out to BYSL)
to: BYSL - Registration 2013 PO Box 4553 Bennington, VT 05201
You can also register online at GotSoccer.com
BYSL is USYSA and VSA AFFILIATED