Thomas Johnson Area Youth (“TJAY”) Soccer Club
Player Registration Form
Refund Policy: If requested before the first game of the season, player registration fees, less a $25.00 admin fee, will be refunded. No player registration fee refunds will be granted after the first game of the season unless approved by the Board.
Instructions: In order to complete the registration process you will need to:
- Submit a complete Player Registration Form including agreeing to the:
- Frederick County Youth Soccer League Medical Release and Waiver of Liability
- Parent Code of Conduct
- Photo Release Waiver
- Provide TJAY Soccer your child’s Proof of Age (i.e. Birth Certificate)
- Pay the appropriate Player Registration Fee
Players will not be permitted to participate if payment is not made. If you are having financial difficulties please go to and download our financial aid form.
Check/money order payments, financial aid forms, and birth certificates can be mailed to:
TJAY SOCCER, PO BOX 1591, FREDERICK, MD 21702
Thomas Johnson Area Youth (“TJAY”) Soccer Club
Player Registration Form
Player Name:______
(First, Middle, Last)
Player Gender (circle one)MaleFemale
Parent 1 Name ______
(First, Middle, Last)
Parent 1 Address:______
(Number, Street, City, State, Zip Code)
Parent 1 Phone:______
(Home (primary) Cell
Parent 1 Email Address:______
All communication will be by email or text only. If you do not have an email address write “None”
Parent 2 Name ______
(First, Middle, Last)
Parent 2 Address:______
(Number, Street, City, State, Zip Code)
Parent 2 Phone:______
(Home (primary) Cell
Parent 2 Email Address:______
All communication will be by email or text only. If you do not have an email address write “None”
Medical Information (Note: You are required to provide this information to participate)
Medical Insurance Provider:______
Medical Insurance Plan Number:______
Player’s Physician:______
Physician’s Phone Number:______
Physician’s Address:______
Player Allergies or Known Medical Conditions:______
Grade (circle one):
PreschoolK1st2nd3rd4th5th6th7th8thHigh School
Fees:
_____ $60.00In House - ages 4 -5 (Pre-K and K) (fee includes player shirt)
_____ $50.00In House – 2nd + child ages 4 -5 (Pre-K and K) (fee includes player shirt)
_____ $60.00Penta – ages 6 – 7(1st and 2nd grade)
_____ $50.00Penta – 2nd + child - ages 6 – 7(1st and 2nd grade)
_____ $100.00U10 – U14 FCYSL – ages 8 – 13
_____$90.00 U10 – U14 FCYSL – 2nd + child - ages 8 – 13
_____$115.00U19 FCYSL – ages 14 – 18
_____$105.00U19 FCYSL - 2nd + child – ages 14 – 18
Volunteer Opportunities:(circle one or more):
TJAY Soccer is an all volunteer organization. Please look over the volunteer opportunities listed below and circle one or more those areas in which you would be willing to help.
Head CoachAssistant CoachTeam ManagerIn-House Coordinator
Field Maintenance Team Board RepresentativeConcessions Volunteer
If you are unable to volunteer, we ask that you add a donation of $10 to your registration fee.
Yes, I would like to donate $______
Coach Preference (if any / not guaranteed):______
Name(s) of Friend(s) player would like on their team(if possible):
______
Player Uniform Size(circle one): Youth S Youth M Youth L Adult S Adult M Adult L Adult XL
Penta - U14: Will you be ordering a new uniform this year?(circle one) YesNo
(Answer "no" if registering for In-House)
(All players (except in-house) are required to wear the official TJAY Soccer Club uniform purchased at Frederick Soccer Supplies.)
Penta - U14. If ordering a new uniform, list your top 3 number preferences: ______
Answer "None" if you will not be ordering a new uniform this season or if you are registering for In-house.)
Penta - U14. If not ordering a new uniform this season, enter the number ______
on the jersey the player will be wearing this season.
(Answer "None" if you are ordering a new uniform this season or if you are registering for In-house).
FREDERICK COUNTY YOUTH SOCCER ASSOCIATION
MEDICAL RELEASE AND WAIVER OF LIABILITY
The above registered child has my permission to participate in the Frederick County Youth Soccer Association sponsored practices, events and games. I realize by participating in these activities, he/she may become injured. I certify that he/she is physically able to participate in a competitive soccer program.
I give my permission for any and all medical attention necessary to be administered to the above named participant in the event of an accident, injury or sickness, under the direction of the authorized person(s) named below until such time as I may be contacted. I also assume responsibility for payment of any such treatment.
In consideration of being permitted to participate in soccer activities, I do hereby for myself, and as parent and/or legal guardian of the above registered child, my heirs, executors, administrators, agents and assignees release and forever discharge event sponsors, coaches, the TJAY Soccer Inc., the Soccer Official Services, the Frederick County Youth Soccer Association, their agents, predecessors, successors and assigns, and all other persons involved in organizing and managing these events from all claims, demands, losses, damage actions, cause of action or suits at law or inequity of whatsoever kind of nature, arising out of soccer activities, including without limitation, any claims for personal injuries or losses to the aforementioned participant, which I may otherwise be able to assert either on my own behalf or on behalf of that aforementioned participant.
AUTHORIZED PERSON(S): TJAY Coaches, Emergency Medical Personnel
I agree with the conditions of this waiver
CONCUSSION AWARENESS
I acknowledge that I have reviewed the information on the TJAY Soccer Club’s website on all of the following:
* The definition of a concussion
* The signs and symptoms of a concussion to observe for or that may be reported by my athlete.
* How to help my athlete prevent a concussion
* What to do if I think my athlete has a concussion, specifically, to seek medical attention right away, keep my athlete out of play, tell the coach about a recent concussion, and report any concussion and/or symptoms to appropriate medical personnel.
I agree with the information presented above.
PHOTO RELEASE WAIVER
I grant the Thomas Johnson Area Youth (“TJAY”) Soccer Club, its representatives and employees the right to take photographs of me, my children, and my property.
I authorize the TJAY Soccer Club, its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree that TJAY Soccer Clubmay use such photographs of me, my children, or my property with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
I agree with the conditions of this waiver
PARENT’S CODE OF CONDUCT
The following Code of Conduct for parents is intended to promote the belief that everyone has a responsibility to follow the principles of good sportsmanship. The emphasis is that respectful relationships between people sends a clear message to everyone participating that what is important is not who wins or loses but how the game is played and watched. The purpose of the code is to assure parents understand and behave at all times in a positive and supporting manner. Key points of the Code of Conduct are shown below.
1.) Exemplify good sportsmanship at all times.
2.) Teach your child to always respect the coaches, referees, and their teammates.
3.) Learn the local rules of the games and help your child understand the rules.
4.) Encourage your child to practice in order to improve their skill level and help them to understand the importance of good sportsmanship at all times.
5.) Do not ridicule or shout at your child, or other children for making mistakes.
6.) Set a good example. Both players and coaches are looking to you as a role model for proper behavior during both practices and games.
7.) Applaud good plays by your team and by members of the opposing team but refrain from coaching or directing players during the game.
8.) Allow the players to play, the coaches to coach, and the referees to officiate.
9.) Never question, complain or argue with a referee's judgment call. Be a good example for your child.
10.) Recognize the importance of and value of coaches who volunteer their time to teach and lead the team. Without them there would be no sports program.
11.) Communicate directly with the coach in a positive manner with concerns for your child. This communication must not occur during a game and must be done privately. Playing time and position is addressed in the rules and is at the coach’s discretion within these rules.
12.) Under no circumstances should inappropriate language be used at any time during a practice or game.
13.) Help ensure that players are on time to every game and practice.
14.) Accept the results of each game. Encourage your child to be gracious in victory and turn defeat to positive experience for improvement.
This Code of Conduct is not all inclusive. Any complaints regarding parent behavior must first be directed to the President. If the problem is not resolved, it will be brought before the TJAY board. The decision made by the TJAY board.
I agree with the conditions of this Code of Conduct
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