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Salt City Tournament - Player Registration |
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| PLAYER NAME: _________________________________________________________________ | |||
LAST, FIRST, MI |
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| ADDRESS: _______________________________________ | ________________________ | __________________ | |
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NUMBER AND STREET |
CITY |
STATE and ZIP |
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| PHONE (HOME): ________________________________ | EMAIL ADDRESS:_________________________________ | ||
| DATE OF BIRTH: __ __ - __ __ - __ __ |
MALE: _________ FEMALE:_________ |
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| M M - D D - Y Y | |||
| FATHERS NAME:________________________________ | MOTHERS NAME:______________________________ | ||
| PHONE (HOME):________________________________ | PHONE (HOME):_______________________________ | ||
| PHONE (WK):__________________________________ | PHONE (WK):_________________________________ | ||
| CELL PHONE:__________________________________ | CELL PHONE:_________________________________ | ||
| EMAIL ADDRESS:_______________________________ | EMAIL ADDRESS:______________________________ | ||
| AGE LEVEL ENTERED:___________________________ |
BOYS___________ GIRLS___________ |
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| TEAM NAME:__________________________________ | COACHES NAME:______________________________ | ||
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I the parent/guardian of the registrant & minor agree that I & the registrant will abide by the rules of the USYSA, it's affiliated organizations, & sponsors recognizing the probability of physical injury associated with soccer & in consideration for the USYSA accepting the registrant for it's soccer programs & activities, hereby release, discharge, and/or otherwise indemnify the USYSA, it's affiliated organizations and sponsors, their employees & associated personnel, including the owners of fields & facilities utilized for programs, against any claim by or on behalf of the registrant, as a result of the participants participation in the programs and/or being transported to/from the same which transportation I hereby authorize. |
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| __________________________________________ | |||
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PARENT/GUARDIAN SIGNATURE |
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DATE: ___________________________________ |
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| Registration Fee Paid: | Cash__________________ | Check#________________ | |