1. Healthcare

GEORGIA YOUTH SOCCER CLUB
Spring 2015 Registration FORM
(Fill out a separate form for each player being registered)
Last Name: _____________________ First Name: __________________________________
Birth Date: ______________ Gender: M or F
Team (circle one) U8, U10, U10, U12, U14
1st Year GYS Spring Player or Returning
Address: _______________________________________________
Town: ________________________ Zip: ____________
Home Phone Number: ____________________________
Email address: _____________________________________
Guardian’s Name&Cell Phone Number: ___________________________________________
Guardian’s Name &Cell Phone Number: ___________________________________________
Shirt Size: YS YM YL AS AMAL Player: 1st Year / Returning
Birth Certificate:(needed for 1st year players) ___ Copy included
Not required (for returning players)
Head Shots: Required for all players –REGISTRATION will be INCOMPLETE until one is
received (please email photo to [email protected])
Medical Information
Known allergies or other pertinent medical information:
____________________________________________
If there is a medical problem, what intervention is required:
________________________________________
Person to notify in emergency: Phone Number: ____________________________________
Doctor to notify in emergency: Phone Number:_____________________________________
Primary Medical Insurance Company: ____________________ Policy #: __________________
Release & Consent for Medical Treatment
I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of
the USYS/USS, itsaffiliated organizations and sponsors. Recognizing the possibility of physical injury
associated with soccer and inconsideration for the USYS/USS and its affiliates accepting the registrant for
its soccer programs and activities (the“Programs”), I hereby release, discharge and/or otherwise
indemnify the GSC, USYS/USS, its affiliated organizations andsponsors, their employees and associated
personnel, including the owners of 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. My child has received a physical
examination bya physician and has been found physically capable of participating in the Programs.
As the parent or legal guardian of the above-named player, I hereby give consent to GSC coaches and/or
representativesto act as a surrogate for my child in the area of obtaining emergency medical care
treatment by a doctor of medicine ordentistry. I also assume the financial responsibility for any medical
treatment for my child.
Signature of Parent or Guardian: ___________________________________ Date: ________
Parent Volunteers
This program is only successful through the efforts of our parent volunteers. We ask for active
participationfrom parents. Please check area(s) in which you would be willing to help.
___ Head Coach: (Team ________________) ___ Field Prep & Upkeep ___Team “Parent”
Fees:
U8 Coed – 8 and under as of Aug 1st, 2015 $80
U10 – 10 and under as of Aug 1st, 2015 $100
U12 – 12 and under as of Aug 1st, 2015 $110
U14 – 14 and under as of Aug 1st, 2015 $110
Make your check payable to Georgia Youth Soccer and mail with completed forms and
birth certificate if first year to:
GYS
33 Goodrich Hill Rd
Georgia, VT 05454
Email: [email protected]
* Each player will receive a numbered team shirt
PAYMENT DUE DATE: JANUARY 31, 2015
After March 1st, 2015 fees are non-refundable. If before March 1st, please contact GYS to
discuss arefund.
Things you should know:
Georgia Soccer Club plays in the VT Soccer League (VSL). This is a competitive
league andalthough GSC encourages all participants - equal playing time is not
guaranteed and left up to thecoach’s discretion based on skill, attitude and commitment.
If you are accustomed to GEMS fall soccer and this is your first time with spring soccer,
you need tounderstand the major differences between the two leagues:
1. Travel is required for away games (home games are played at GEMS)
2. There must be a commitment from players & parents to participate in practices and
games
3. Our team will play skilled teams outside of our GEMS organization
4. Practices typically begin (in the GEMS gym) around the beginning of March and
move outside whenthe weather permits. Games start shortly thereafter and the season
ends in June.
5. Games are scheduled by VSL giving us no control over them, they are typically on
weekends.
Important Websites:
Georgia Soccer: www.leaguelineup.com/georgiasoccer
Schedule: www.vermontsoccerleague.org
VSL site: www.vermontsoccer.org