RYSC
ROTTERDAM YOUTH SOCCER CLUB
   Rotterdam, NY   USA

    

Fall Recreation Signup Form

Player(s) Information
Please fill in the information for all participating children in your family
NOTE: KEEP ALL INFO TOGETHER FOR EACH PLAYER.
(Example: Registering one child if you put info on other line(s) in another player's area (which is empty) will we not see it!-- Don't do this.

Player 1

Player 2
Name:   Name:  
Date of Birth:(mm/dd/yy)   Date of Birth:(mm/dd/yy)  
Gender:   Male   Female Gender:   Male   Female
School Name:   School Name:  
Grade (in Sept 2014):   Grade (in Sept 2014):  
Shirt/Shorts Size:   Shirt/Shorts Size:  
           
Has this child previously played recreation soccer?

  Yes    No Has this child previously played recreation soccer?

  Yes    No
Has this child previously participated in a travel program?   Yes    No Has this child previously participated in a travel program?

  Yes    No
Buddy Request : You may request that your child play on the same team as one friend or sibling if that child is in the same group division. In order for your child to be “buddied up” both forms must contain the corresponding buddy’s name.


Indicate the “BUDDY” name(s) here for
Player 1:

Indicate the “BUDDY” name(s) here for
Player 2:




Player 3

Player 4
Name:   Name:  
Date of Birth:(mm/dd/yy)   Date of Birth:(mm/dd/yy)  
Gender:   Male   Female Gender:   Male   Female
School Name:   School Name:  
Grade (in Sept 2014):   Grade (in Sept 2014):  
Shirt/Shorts Size:   Shirt/Shorts Size:  
           
Has this child previously played recreation soccer?

  Yes    No Has this child previously played recreation soccer?

  Yes    No
Has this child previously participated in a travel program?   Yes    No Has this child previously participated in a travel program?   Yes    No

Buddy Request : You may request that your child play on the same team as one friend or sibling if that child is in the same group division. In order for your child to be “buddied up” both forms must contain the corresponding buddy’s name.

Indicate the “Buddy” name(s) here for
Player 3:

Indicate the “Buddy” name(s) here for
Player 4:



Parent/Guardian Name: (1 name per space)        
Parent/Guardian Phone
(518-555-1212):
       
Parent/Guardian Name:        
Parent/Guardian Phone
(518-555-1212):
       

Please indicate player’s special medical/physical condition(s).
If no such condition exists, write “NONE”.
If registering more than one child, please use player number (P1..P2 etc..)
to indicate which child has a medical condition. (i.e. P1 - Asthma P2 - NONE)

Note: Put the medical condition in this field only, if you have other concerns send a separate email to: fallrec@rysc.org



All parents/guardians are expected to contribute to our all-volunteer program. Please look at the list below and indicate your willingness to volunteer by checking as many areas as possible.
Team Activities Club Activities  
Head Coach* Field Set-Up Field Take Down
Assistant Coach* Concession Stand Sponsor/Solicit Ads
Team Parent Field Clean Up  
   

Parent/Guardian Billing Information
Name:  
Address:  
City:  
State:  
Zip Code:  
Email Address:        
Phone Number:
     (518-555-1212)
       
           
Amount To Charge:        
         
Credit Card    
Cardholder Name:        
Card Type:        
Card Number:        
Expiration Date:   /      
         
Check    
Your Check/MO* #
* Enter your check number in box. If paying with a MO (money order) and don't have one in your possession at this time, just type 999 in this space.
Please mail payment within 1-2 days of registering
and make sure your phone number is on your payment.

Make your check or mo payable to: RYSC
Mail your payment to:
RYSC c/o Bob DiBella
2048 Careleon Road
Schenectady, NY 12303

Thank you!
       
           

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 the possibility of serious injury. Recognizing that such risks exist, I give my permission for my child to participate in this activity. I give permission to authorize medical treatment for my child should the need arise. Also, I give my consent to any photos taken of my child can be used on the RYSC website for the purpose of advertising this program.


I agree to the statement above.

         

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