Mariner Youth Soccer
SMSL Registration Form: Summer 2016
** Registration Must Be Received by JUNE 10, 2016**
Name: ____________________________________________________________________
Address: __________________________________________________________________
Home Phone: __________________________________________
E-Mail: ________________________________________________
Birthdate MM/DD/Year: _________________ Grade Fall 2016:__________________
T-Shirt Size: XS
S
M
L
XL
Goalkeeper: Y
N
Person to notify in case of emergency while child is on the field: _______________________________
Cell Phone: _____________________________________
Medical Problems Issues:_____________________________________________
Mother’s Name
Home #
Work #
Cell #
Father’s Name
Home #
Work #
Cell #
I, the parent/guardian of the registrant, a minor, agree that I and the
registrant will abide by the rules of the USYSA, its affiliated
organizations and sponsors. Recognizing the possibility of physical
injury associated with soccer and in consideration for the USYSA
accepting the registrant for its program and activities (the
“programs”). I hereby release, discharge and/or otherwise
indemnify the USYSA, its affiliated organizations and sponsors,
their employees and associated personnel, including the owners of
fields and facilities utilized for the Programs, against any claim by
or on the behalf of the registrant as a result of the registrant’s
participation in the Programs and/or being transported to or from
the same, which transportation I hereby authorize. I also agree to
the Registration Rules found on the back of this form.
________________________________
Signature
Consent for Medical Treatment, Minor
As parent or legal guardian of the above named
player, I hereby give my consent for emergency
medical care prescribed by duly licensed Doctor
of Medical or Doctor of Dentistry. This care may
be given under whatever conditions are necessary
to preserve life, limb, or well being of my
dependent.
_____________________________
Signature
REGISTRATION RULES – SUMMER 2015
Eligible players – entering 9th – 12th grade (Fall 2016)
Registration Checklist:


Please sign the two (medical and liability) release areas on the front of this form
A photocopy of the player’s birth certificate must be included with registration.
The photocopy will not be returned. (New Players ONLY)
 Payments should be made to your Manager, as Mariner charges one fee per Team. Confirm per player
amount with your Manager.