Ketchikan Youth Soccer League
2016 INDOOR SOCCER
Registration dates: November 1 – December 1, 2015
P.O. Box 5271, [email protected], 225-5975
Season begins week of January 4th
Registration Fees:
$85.00 Nov. 1-Dec. 1 $100 late registration after Dec. 1
IMPORTANT:
**There is no guarantee of team placement! Once a division is filled, a wait list will be started.
**KYSL does not ‘play up’ participants.
DIVISIONS by grades: please check one
____ 2nd & 3rd grade
____4th & 5th grade
Please use only one form per child!
Birth Date m/d/y______________________
M
Current Grade:
F
_______________
School: _____________________________________
If this is your first time playing soccer in Ketchikan,
have you played indoor soccer before?
If yes, years of experience: _________
Player’s email (if applicable):
___________________________________________
Father’s Name: ______________________________
Address
____ 9th-12th grade
Release of Liability:
Name: _____________________________________
Circle One:
____6th-8th grade
______________________________
In consideration for permitting my child to participate as a player
in the Ketchikan Youth Soccer League (KYSL), I hereby waive,
release and discharge Ketchikan Youth Soccer League (KYSL),
Alaska Youth Soccer Association (AYSA) its officers, board
members, coaches, referees, players and successors from liability
of any nature whatever arising from or growing out of the
participation of my child in any of the activities of KYSL/AYSA.
The undersigned parent/guardian of the above minor does hereby
authorize the officers, coaches or agents of the KYSL to transport
as required the above minor to and from authorized KYSLSPONSORED activities.
CONSENT FOR MEDICAL TREATMENT;
I hereby give my consent to all medical care prescribed by a duly
licensed Doctor of Medicine for my child as his/her parent/legal
guardian. This care may be given under whatever conditions are
necessary to preserve the life, limb or well being of my dependent.
Parent/Legal Guardian:
Printed Name______________________________________________________________
Signature ______________________________________Date ______________________
City/State/Zip________________________________
Home Phone:
Cell:
______________________________
____________ Wk:
_________________
Father’s E-mail:______________________________
Coach? YES NO Assistant Coach?
Referee?
YES
YES
NO
NO
Mother’s Name: ______________________________
Address
______________________________
City/State/Zip________________________________
Home Phone:
Cell:
______________________________
____________ Wk:
Coach? YES NO Assistant Coach?
YES
YES
NO
NO
Please list siblings playing in same
division:
_________________________
Office use:
________
Date
________________________________________________ ___________________
Activity
Dates
________________________________________________ ___________________
Activity
Dates
_________________
Mother’s E-mail:_____________________________
Referee?
KYSL strives to keep all teams equal and balanced. We
will not be able to accommodate player, carpool or
coach request. We will not be able to accommodate or
consider conflicts with other activities, but would like to
avoid a concentration of players with the same activities
on one team.
Extracurricular Activities (i.e. dance, swim, b-ball, etc.)
only during soccer season
____________
Pymt.
RULES ON JEWELRY AND ADORNMENT:
KYSL subscribes to safety rules applied around the
world in youth and adult soccer. Jewelry and
adornment of all kinds are prohibited. These include
rings, ear jewelry, facial jewelry, necklaces, bracelets
and watches. Metal may not be worn in the hair.
Headgear may not have knots or other items that
might harm the wearer or opponents.