NILES YOUTH SOCCER

LEAGUE REGISTRATION

All communities WILL BE COMBINED to form a general pool of co-ed players.

$65 per child U6 and up.

$55 per child U4.

includes shirt, shorts, socks, insurance, referee fees and trophies.

Send registration, medical form and fee to:

N.Y.S.L.

P.O. Box 322 Niles, Ohio 44446

PLEASE DO NOT SEND CASH IN THE MAIL

MAKE CHECKS PAYABLE TO N.Y.S.L.

A fee of $40.00 will be charged for all returned checks. All fees are due prior to the start of games.

Player’s registration fee $______

How paid: ______cash ______check check no. ______

Received by ______

BIRTH DATE VERIFIED ______yes ______no

VERIFIED BY ______

N.Y.S.L. SOCCER REGISTRATION (PLEASE PRINT CLEARLY)

Date ______

Last name ______First______m.i.______Sex ______

Address ______

City & Zip ______

Birth date ______

Last year’s team ______No. of years played ______

_____check if you have played high school soccer ______No. of years in high school soccer

Fathers name ______Mothers name ______

Email address ______

YOU ARE STRONGLY URGED TO REGISTER IN PERSON SO UNIFORMS MAY BE TRIED ON TO ASSURE CORRECT FIT.

Check if you are first year player for NYSL ______FIRST YEAR REGISTRAINT MUST PROVIDE BIRTH CERTIFICATE
OTHER CHILDREN FROM FAMILY PRESENTLY IN LEAGUE I/we, the parent or guardian (s) of the above-namedcandidatefor a
______age______position in the N.Y.S.L. hereby give my/our approval to participate in any
and all N.Y.S.L. activities. We assume all risks and hazards incidental to such
______age______participation including transportation to and from all activities; I/we do
hereby waive, release, absolve, indemnify, and agree to hold harmless the
______age______N.Y.S.L., their organizers, sponsors, supervisors, participants, and persons
transporting my/our child to and from activities, for any claim arising out
______age______of injury to my/our child. whether the result of negligence or for any other
cause, except to the extent and in the amount covered by accidental/
liability insurance.

I/WE will furnish a certified birth certificate of the above-named candidate upon request of league officials.

Signature ______Date ______

UNIFORM SIZEyouthadult

Shirt sizeXSSMLSMLXL

Short sizeXSSMLSMLXL

VOLUNTEERS NEEDED: The league requests active participation of all parents in our program.

Please check area (s) in which you can help (you may check more than one).

____sponsor_____coach_____ asst. coach____referee_____concession worker

NILES YOUTH SOCCER LEAGUE

MEDICAL HISTORY

RETURN WITH APPLICATION

Name ______phone ______

Address ______city ______

Parent/guardian name______

  1. Allergies (drugs, environmental, bees, wasps, etc.)______yes______no
  2. History of epilepsy/convulsions______yes______no
  3. History of diabetes______yes______no
  4. Is the child taking and medications______yes______no if so, what? ______

Previous injuries (broken bones, sprains, head injuries) ______

Name of family physician ______

Name of family dentist ______preferred hospital______

Person to notify in emergency ______phone ______

Any additional medical information ______

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/Dentistry, this care may be given under whatever conditions are necessary to preserve life, limb or well-being of my dependent.

SIGNATURE OF PARENT OR GAURDIAN

X ______

ADDRESS ______

CITY ______STATE ______ZIP ______

PHONE: HOME ______CELL ______BUSINESS ______