TRSA REGISTRATION FORM
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PLAYER’ NAME: _____________________________________ DATE OF BIRTH ____/____/____ BOY  GIRL |
| ADDRESS: _______________________________________________________ New Member Returning Member |
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CITY: _____________________________________________ STATE: _____________________ ZIP: _________________
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| MOTHER’S NAME: ______________________________________ |
HOME PHONE #: (_____) ______-___________ |
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CELL PHONE #: (_____) ______-___________ |
| FATHER’S NAME: _____________________________________ |
HOME PHONE #: (_____) ______-___________ |
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CELL PHONE #: (_____) ______-___________ |
| Check here if have or had a child with TRSA in last five years. |
| SOCCER EXPERIENCE: Have you played on a team before? Yes No |
Team Name:_________________ |
| COMMENTS:___________________________________________________________ |
Club Name:__________________ |
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| Do you have a Medical Condition that a coach should be made aware of? Yes No |
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If yes, Explain: |
____________________________________________________________________________________ |
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____________________________________________________________________________________ |
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| REGISTRATION FEE: $_______________ Check #: __________________ (Please, do not send cash) |
IMPORTANT:
I, the Parent/Guardian of the registrant, a minor, agree that I and the registrant recognize that periodic fund raising is required of all TRSA members and that further, we will abide by the rules of the USYS and NJYS and it’s affiliate organizations & sponsors, including TRSA. Recognizing the possibility of physical injury associated with soccer and in consideration for the NJYS accepting the registration for it’s soccer program & activities (the program), I hereby release, discharge/or otherwise indemnify the USYS, it’s affiliate organizations & sponsors, including TRSA, their employees & associated personnel, including the owners of fields & facilities used by the program against any claim by or on behalf of the registrant as a result of the registrant’s participation in the program and/or being transported to or from the same, which transportation I hereby authorize. |
Parent/Guardian’s Signature: _________________________ ____________________________ Date: ____/____/_____
(Please Print Name Here) |
