Genoa soccer club east surburban soccer league

Genoa SOCCER CLUB EAST SURBURBAN SOCCER LEAGUE

FALL 2016 REGISTRATION FORM

FORM POST-MARKED BY July 30, 2016

FORMS POST-MARKED AFTER July 30, 2016 NOT ACCEPTED

Player’s First Name Player’s Last Name Phone Number

Address P. O. Box/Lot No. City Zip School Child attends

/ / Male or Female Yes or No

Date of Birth Age (as of 07/31/15) Gender Returning GARS Player?

Mother’s Name Alternate Phone Number (Cell/Work) Email Address (for GARS use only)

Father’s Name Alternate Phone Number (Cell/Work) Email Address (for GARS use only)

PLAYER SHIRT SIZE:	Youth sizes: Y-Small Y-Medium Y-Large
Adult sizes: A-Small A-Medium A-Large A-XLarge

Registration Fee: $43.00 (per child) includes uniform for U8 through U14. Registration Fee for U6 (per child) includes shirt $ 33.00 Late fee after 7/30/2016 add $10 (per child, no exceptions) Registering three or more children? Pay a flat fee of $115. Please fill out a form for each child. Mail with payment to: Genoa Area Rec Soccer, 22050 Hollyhock Ln, Curtice, OH 43412 Questions? Please refer to our website: www. genoarecsoccer. org For questions/concerns please contact Sara Houghtaling - call/text 419-266-3864 or email *****@***com

Refund requests must be in writing. No refunds will be given once rosters are completed.

U14 MAY BE CO-ED

Teams are Selected via Blind Draw by the ESSL. Coach requests are no longer accepted. Parents we need your help! Please indicate how you could help (circle all that apply). Thank you! Coaches children will receive a discount registration! New to soccer? Coaches, Refs and PARENTS always have free access to SAY’s online coaching and training resources. www. saysoccer. org Board member Coach Assistant coach to: _______________________ Referee Volunteer

Players Team Agreement

WE HEREBY AGREE THAT THE SOCCER ASSOCIATION FOR YOUTH (SAY), (ITS MEMBERS, COACHES OR OFFICERS) SHALL NOT BE LIABLE FOR ANY INJURY OR LOSS WHICH MY CHILD MAY SUSTAIN WHILE PARTICIPATING IN ACTIVITIES OF ANY KIND WHETHER SPONSORED BY OR UNDER THE SUPERVISON OF SAY AND WE AGREE TO INDEMNIFY AND TO HOLD HARMLESS SAY, ITS MEMBERS, COACHES, OFFICERS OR DESIGNATES OF ANY KIND FROM ANY CLAIM WHATSOEVER.

Parent or Guardian Signature_______________________________________________________________________________Date_____________

I, the parent/guardian of the registrant, a minor, by signing below, agree that the registrant and I will abide by the rules of the soccer league and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the league accepting the registrant for it’s soccer program and activities, I hereby agree to release, discharge, hold harmless and/or otherwise indemnify Genoa Area Recreational Soccer, ESSL and it’s affiliated organizations and sponsors, volunteers and officials, including the owners of the fields and facilities used for soccer programs, against any claim by or on my behalf of the registrant as a result of the registrant’s participation in the soccer program and/or being transported to or from the same, which transportation I hereby authorize.

CONSENT FOR MEDICAL TREATMENT: As a parent/legal guardian of the above named registrant, I hereby give consent for emergency medical care prescribed by a duly licensed doctor of medicine or dentistry. This care may be given under whatever conditions are necessary to preserve the life or well being of my dependent.

Parent or Guardian Signature_______________________________________________________________________________Date_____________

Does this child have any allergies or require any special medication? YES or NO (Circle one). EXPLAIN:__________________________

________________________________________________________________________________________________________________

For GARS use only: Date Received: ____/____/____ Check__________ Cash __________Amount______________ Age: _______ B G Division: U6 U8 U10 U12 U14 ESSL approved to move up one age group? Y N