www.ntxsoccer.org

 

RECREATIONAL

MEMBERSHIP FORM

                                                               

 

                                                                Revised 5/00

 

FOR LEAGUE

USE ONLY

ð TRANSFERS

ð  NEW

ð  REREGIST-

      RATION

ð  CHANGE/   CORRECTION

 

Team Name

 

Age Group:

U-

 Player/Coach Registration #:

 

 

 

Last Name:

 

 

 

First Name:

 

 

 

Init

 

Player:

 

 

Coach:

 

Lic:

 

Street Address:

 

Apt #:

 

City:

 

St:

TX

Zip Code:

 

Phone #:

(      )

DOB:

 

Age:

 

Sex:

 

E-mail Address:

 

Father’s Name:

 

Occupation:

 

Work Phone #:

(        )

Mother’s Name:

 

Occupation

 

Work Phone #:

(        )

E-Mail Address:

 

Person in an emergency:

 

Phone #:

(        )

Doctor to Notify:

 

Phone #:

(        )

List any Medical Problems:

 

 

# of Seasons Played

Last Team

Last Association

Date of Last Season

Height

Weight

School

Grade

 

 

 

 

 

 

 

 

UNIFORM SIZE (circle one)

Other Children in family Presently in League

Age

 

 

Youth

 

Adult

 

 

 

 

Shirts

XS   S   M   L   XL

XS   S   M   L   XL

 

 

Shorts

XS   S   M   L   XL

XS   S   M   L   XL

 

 

Socks

XS   S   M    L   XL

XS    S   M   L   XL

 

 

IMPORTANT

I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the USYS, it’s affiliated organizations and sponsors.  Recognizing the possibility of physical injury associated with soccer and in consideration for the USYS accepting the registrant for its soccer programs and activities (the APrograms@).  I hereby release, discharge and/or otherwise indemnify the USYS, its affiliated organizations and sponsors, their employees and associated personnel, including the registrant as a result of the registrant, participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.  I further grant the USYS Parties the right to use the player’s name, pictures and /or likeness in printed, broadcast and other material concerning the Programs provided such use is related to the player’s status as a participant in the Programs.  Any recreational player currently rostered to a recreational team and wishing to be released to join a competitive team may do so only between December 1 and March 15 may do so only with the written permission of the Member Association in which he/she is currently rostered.

 

Name:                                                                                                                                                                                                                                                                                    Parent/Legal Guardian (please print)

 

Signature: X                                                                                                                             Date:                       

 

PARENTAL SUPPORT

We ask for active participation of all parents in our program.  Check area(s) in which you would be willing to help.

 

 ð  Coach                               ð Committee

 ð  Asst. Coach                    ð Referee

 ð  Team Mgr                        ð Fund Raising

 ð  Team Parent                    ð clerical

 ð  Special Projects            ð  Reporter

 ð  Field Preparation         ð  Newsletter

 ð   Board Member               ð Concessions

 ð   Publicity                        ð  Donor

 

Other:                                                           

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.

 

Signature of Parent or Guardian  X                                                                                                                                                                             

 

Address:                                                                                   Apt #:                              

 

City:                                                                         TX     Zip code:                             

 

Phone: Home (           )                            Bus.: (              )                                     

 

OFFICIAL USE ONLY        Picture Received    Yes    No

 

Registration Fees $                                  Birth Date Verified       Yes     No

 

Player Fee                            $                                               

 

Coaches Fee                        $                                             

 

Other                                     $                                                    

                                                                       

TOTAL  Received             $                                               Still Owes $                       

 

Cash                                       Check #                                                                              

                                                                                                                             Date