WestMYSA
Registration Form
June 2008

Type of Application (Circle or Highlight One)

Teams may register a coach, asst. coach and manager. Managers are not required to register. If manager does not register, a second asst. may register as manager.

Player (Under 18)


Player (18 & Over)

Head Coach

Asst. Coach

Manager

E or D License?

Date Issued:

Club Trying Out For (Circle or Highlight One)

Battle Creek
Force
Kalamazoo
Invaders

Marshall
Michiana
Niles

Portage
Red Arrow
River Oaks
South Haven

Sturgis
SW Michigan
Sting
Three Rivers

Other

Under 10
Under 11
Under 12
Under 13
Under 14
Under 15
Under 16
Under 17
Under 18
Under 19

Male Female          Parent E-mail #1:  
                                          Parent E-mail #2:
School District of Residence:     Fall School Grade Level:

Last Name:     First Name:     M.I.

Address:     City:     State:

Full Zip + 4:    Birthdate (MM/DD/YY):

Phone #1:
Phone #2:

 
I, the player/coach/manager listed above (or parent if player is under 18), agree that I will abide by the rules of MSYSA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer, and in consideration for MSYSA accepting me for it soccer program, I hereby release, discharge and/or otherwise indemnify the MSYSA, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the programs, against any claim by or on behalf of myself as a result of my participation in the programs and/or being transported to or from the same, which transportation I hereby authorize. I also agree that good sportsmanship and a sense of fair competition will govern my conduct on the field. I understand that players/coaches who are guilty of major transgressions (violence, racial abuse, abuse of a referee, etc.) will be referred to the WestMYSA Board for suspension and/or loss of pass card. All players/coaches/managers and parents (if player is under 18) must sign below to acknowledge having read and understood the above.
Dual Registrations: Any player who dual registers must abide by WMYSA rules at www.wmysa.org
Parents and Club Representatives: To ensure registration, include ALL requested information on this form.
To keep multiple submissions to a minimum, please review the data above for accuracy before pressing the Submit Registration button.

NOTE: After pressing the Submit Registration button, a complete WestMYSA registration form will be displayed with your information. Please print that page and bring it to tryouts along with a picture and, if not registered prior season, a birth certificate.

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