Big Bend Youth Soccer Association Coach/Asst Coach Registration Form
Name (as it appears on your driver’s license)* ________________________________________________
DOB* ______________________
E-mail Address ___________________________________________________________________
Cell phone number _______________________________________________________________
Do you have a family member playing Soccer this season that you would like to coach?
Yes
or
No
If yes, child’s name and DOB _______________________________________________________
If you are signing up as an Assistant Coach only, is there a particular Coach you would like to work
with?
Yes
or
No
If yes, what is that Coach’s name ___________________________________________________
CONSENT TO PARTICIPATE IN BBYSA:
I, THE COACH/ASSISTANT COACH, AGREE THAT I WILL ABIDE BY THE RULES OF THE BBYSA, AND WILL MAINTAIN MEDICAL INSURANCE, RECOGNIZING THE
POSSIBILITY OF PHYSICAL INJURY ASSOCIATED WITH SOCCER AND IN CONSIDERATION BY THE BBYSA, ACCEPTING THE COACH/ASSISTANT COACH POSITION
FOR ITS SOCCER PROGRAM AND ACTIVITIES, I HEREBY RELEASE, DISCHARGE AND/OR OTHERWISE INDEMNIFY THE BBYSA, THEIR VOLUNTEER BOARD AND
CONTRACTED PERSONNEL, INCLUDING THE OWNERS OF THE FIELDS AND FACILITIES UTILIZED BY THE BBYSA AGAINST ANY CLAIM BY OR ON BEHALF OF
MYSELF AS A RESULT OF MY PARTICIPATION IN THE BBYSA. I HEREBY AUTHORIZE.
_________________________________
PRINTED NAME
_______________________________
SIGNATURE
___________
DATE
UNIFORM SIZES:
SHIRTS
ADULT
S
M
L
XL
XXL
SHORTS
ADULT
S
M
L
XL
XXL (CIRCLE ONE)
SOCKS
S
M
L
(CIRCLE ONE)
(CIRCLE ONE)
*NOTE: There will be a criminal background check done on all Coaches/assistant Coaches. Your name as it appears on your
driver’s license and date of birth are needed to complete that form.