Ketchikan Youth Soccer League 2015 INDOOR SOCCER

Ketchikan Youth Soccer League
2015 INDOOR SOCCER
Registration dates: November 1 – December 1, 2014
P.O. Box 5271, ktnyouthsoccer@gci.net, 225-5975
Season begins week of January 4th
Registration Fees:
$85.00 Nov. 1-Dec. 1 $100 late registration after Dec. 1
IMPORTANT:
**There is no guarantee of team placement! Once a division is filled, a wait list will be started.
**KYSL does not ‘play up’ participants.
DIVISIONS by grades: please check one
____ 2nd & 3rd grade
____4th & 5th grade
Please use only one form per child!
Name: _____________________________________
Birth Date m/d/y ______________________
Circle One:
M
Current Grade:
F
_______________
School: _____________________________________
If this is your first time playing soccer in Ketchikan,
have you played indoor soccer before?
____6th-8th grade
____ 9th-12th grade
Release of Liability:
In consideration for permitting my child to participate as a player
in the Ketchikan Youth Soccer League (KYSL), I hereby waive,
release and discharge Ketchikan Youth Soccer League (KYSL),
Alaska Youth Soccer Association (AYSA) its officers, board
members, coaches, referees, players and successors from liability
of any nature whatever arising from or growing out of the
participation of my child in any of the activities of KYSL/AYSA.
The undersigned parent/guardian of the above minor does hereby
authorize the officers, coaches or agents of the KYSL to transport
as required the above minor to and from authorized KYSLSPONSORED activities.
If yes, years of experience: _________
Player’s email (if applicable):
___________________________________________
Father’s Name: ______________________________
Address
______________________________
City/State/Zip________________________________
Home Phone:
Cell:
______________________________
____________ Wk:
_________________
KYSL strives to keep all teams equal and balanced. We
will not be able to accommodate player, carpool or
coach request.
Father’s E-mail:______________________________
Coach? YES NO Assistant Coach?
Referee?
YES
YES
NO
NO
Mother’s Name: ______________________________
Address
Extracurricular Activities (i.e. dance, swim, b-ball, etc.)
only during soccer season
______________________________
City/State/Zip________________________________
Home Phone:
Cell:
______________________________
____________ Wk:
_________________
Mother’s E-mail:_____________________________
Coach? YES NO Assistant Coach?
Referee?
YES
YES
NO
NO
Please list siblings playing in same
division:
_________________________
Office use:
________
Date
____________
Pymt.
RULES ON JEWELRY AND ADORNMENT: