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2015 WLYSC BREAKERS Soccer REGISTRATION FORM
COST IS $100 for Fall and $100 for Spring (plus uniform fee)
PLEASE FILL OUT THE FORM COMPLETELY
ONE FORM FOR EACH PLAYER (YOU MAY PAY TOGETHER)
HIT THE SUBMIT BUTTON WHEN DONE
YOU WILL BE DIRECTED TO A NEW PAGE FOR PAYMENT
*
Indicates required field
Player Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Date of Birth (mm/dd/yyyy)
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Grade (Fall of 2015)
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3rd
4th
5th
6th
7th
8th
School
*
Shirt Size (please choose)
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Special Considerations (i.e. unavailable practice nights)
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Parent/Guardian Information
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First
Last
Contact Phone Number
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Alternate Number
*
Email
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Parent/Guardian Information 2
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First
Last
Contact Phone Number 2
*
Alternate Number 2
*
Email
*
Health Concerns (i.e. asthma, injuries)
*
PHOTO RELEASE
WE OCCASIONALLY MAY USE PHOTOGRAPHS OF THE PLAYERS FOR MARKETING MATERIALS OR ON THE WEBSITE, PLEASE CHOOSE "YES" IF YOU APPROVE. THANK YOU.
Choose One (photo release)
*
YES
NO
PARENT & ATHLETE CONCUSSION
INFORMATION SHEET (mandatory)
Please print out the concussion form
HERE
, sign (both parents/guardians and players) and return on the first night of practice. One for each player, not household.
Code of Conduct Form (mandatory)
Click
HERE for the Code of Conduct Form
Please read these rules with your child and make sure you both understand them and agree to follow them. Any violation of these rules will be subject to some form of disciplinary action appropriate to the infractions, up to and including suspension. Any suspension would be subject to approval of the Board of Directors, after meeting with the parents.
Signature (code of conduct)
*
Agree
RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (MANDATORY)
CLICK
HERE FOR FORM
. ONCE READ COMPLETELY, CLICK AGREE BELOW.
BY CLICKING "AGREE" BELOW, I HAVE READ THE ABOVE DOCUMENT AND I HEREBY GRANT MY CHILD PERMISSION TO PARTICIPATE IN THE WHITE LAKE YOUTH SPORTS CLUB PROGRAM. I UNDERSTAND THAT BASKETBALL IS A FULL CONTACT SPORT AND THAT PARTICIPATION IN A CONTACT SPORT INCREASES MY CHILD’S PHYSICAL VULNERABILITY. I ALSO AGREE TO PROVIDE MY CHILD WITH QUALITY PROTECTIVE EQUIPMENT. I HEREBY CERTIFY THAT THE INFORMATION ON THIS FORM IS TRUE AND ACCURATE AND I HAVE READ THE ABOVE FILE COMPLETELY.
Signature (liability release)
*
Agree
Payment Options (choose one)
*
Pay in Person
Pay Online
Submit