CIRCLEVILLE YOUTH SOCCER ASSOCIATION-2012

 
 $25 for 1^st Child- $20 for 2^nd Child
$10 Late Sign Up Fee
*Fee MUST accompany Application
(w/ Copy of Birth Certificate for first year player)

Name:_________________________________________________

  Address: _____________________________________ City :_____________ Zip:______

  Age:________     Sex: M     F       Birth Date:______________    Phone:______________

Shirt Size:  YXS      YS    YM    YL     AS    AM    AL    AXL     (Please circle one)

  Circle Age of Child as of Sept. 30, 2011                     4—5—6—7—8—9—10—11—12

  Circle Grade of Child in Fall of 2011                          Pre-K, K, 1, 2, 3, 4, 5, 6                      Has this child played organized soccer before? Yes     No       School________________
The number of children in an age group and gender  will determine teams

Parent/Guardian:________________________________________________________

Address:________________________________________ Phone:_________________

  Check if you would be willing to help in following areas:    Coach:____________                                            Referee:___________

Instructional Clinics will be held for Coaches & Referees- Your Help is Needed!!!
Please Note: The signature below indicates that I as parent/guardian agree to indemnify and hold harmless each and all of the officers, coaches, volunteers, referees and players of the Circleville Youth Soccer Association against any and all claims arising from injuries caused to or by the applicants. I recognize that the fall league is NOT intended to be a competitive league and is designed for the promotion and development of the participants love, desire and ability to play the game of soccer. I understand that team coaches, referees and league officials are all volunteers and that decisions made during the contests are not open to debate. I will show the utmost sportsmanship towards the players, referees and coaches while
attending sanctioned CYSA events. I agree as parent/guardian, as does my applicant, to honor all rules governing the play of CYSA.
Non-discrimination Statement- CYSA does not discriminate on the basis of race, color, sex, age, national origin, religion or disability. No person will be denied admission to our youth programs on the basis of race, color, religion, sex, national origin or disability.  Any player or parent having inquiries regarding the application of these rights should contact a member of the board of CYSA.

Date:_________________      Parent/Guardian Signature:_________________________
Return Application WITH FEE to:        Circleville Youth Soccer Association
                                                          P.O. Box 952
                                                          Circleville , Ohio 43113