KYSC Academy Night Player Registration Form

Player Information

Name and D.O.B. are required for proper placement
Player's Name*
First Name Last Name
Player's Gender*

Boy Girl
Player's Date of Birth*
Month Day Year

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Is Player currently registered in KYSC program?
If NO, where is the player registered?
T-Shirt Size
Select One T-Shirt Size:*

Youth S Adult S Youth M Adult M Youth L Adult L
Parent / Guardian Information
Parent / Guardian Name*
First Name Last Name
Phone Number*
- Area Code Phone Number
Alt Phone Number
- Area Code Phone Number
Email Address*
Comments
GENERAL LIABILITY - I, the parents/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the USYSA, its affiliated organizations (such as KYSA) and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration by the USYSA, accepting the registrant for its soccer programs and activities (the "Programs"). I hereby release, discharge and/or otherwise indemnify the USYSA, 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 the registrant as a result of the registrant's participation in the Programs and or being transported to or from the same, which transportation I hereby authorize.
General Liability*

By clicking here, you agree with the conditions stated above and acknowledge that all information is correct.
CONSENT FOR MEDICAL TREATMENT (MINOR) - As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.
Medical Consent*

By checking this box, you consent to the terms stated above for medical treatment.
Should be Empty:

Player Information

T-Shirt Size

Parent / Guardian Information