<p>PLAYER’s Last Name: ______First Name: ______MI ______</p><p>Tioga County Youth Soccer Association - TCYSA c/o Jason VanDerpoel, 511 Rt. 34 S, Van Etten, NY 14889 607-481-4748 [email protected] </p><p>For boys and girls age 3 but not yet 13 on Dec. 31 of this year. Kinder Soccer for 3, 4 & 5 year-olds will have its own age-appropriate program</p><p>Cost: BEFORE JUNE 15 – 1 child/$30 2/$60 $70 Max per family AFTER JUNE 15 - $35 per child Registration fee includes insurance, shirt, and socks. No child is excluded for inability to pay, but child MUST register on time to be placed on a team. ALL late registrations (after 6/15) will be placed on a “space-available” basis.</p><p>PLAYER INFORMATION CONTINUED:</p><p>Birth date: Month/Day/Year_____ / _____ / _____ Age on Dec. 31, 2016:______Gender: Male______Female______</p><p>Address: ______Town: ______Zip:______</p><p>Area Code:______Telephone Number:______Email: ______</p><p>School Grade Now:______Age today:______Jersey Size: YS YM YL AS AM AL AXL </p><p>Soccer Experience: ______</p><p>PARENT/GUARDIAN INFORMATION: </p><p>Father’s Name: ______Email:______Occupation: ______Soccer experience :______Cell Phone: ______</p><p>Mother’s Name: ______Email: ______Occupation: ______Soccer experience:______Cell Phone: ______</p><p>MEDICAL INFORMATION: List any medical problem or prohibition player has: ______</p><p>COMMENTS: If you’d like two kids on the same team or same practice night, give their names, birth years and the reason. We will honor requests when we can. No promises are made! ______</p><p>TCYSA NEEDS YOUR HELP! The program runs entirely on volunteers pitching in. Pls. circle where you can help and write the name of the volunteer next to it. </p><p>FUNDRAISING - team candy “mom” or SVE chair (collect/count $) LEAGUE LEVEL: attend board meetings, help organize TCYSA GROUNDS - Lining fields , mowing, litter pick-up, nets up/down, weight goals, weed, brush hog, , etc. TEAM MANAGER - help organize snacks, car pooling, party, announcements - so the coach can just coach! REFEREE COACH Asst. COACH SKILLS: electrical, painting, carpentry, maintenance, plumbing or ______</p><p>I, as parent/guardian of the player named above, give permission for my child to play soccer and will not hold the Tioga County Youth Soccer Association (TCYSA) or any of its officers, coaches, referees, other volunteers or its sponsors responsible for injuries which may occur. I release SVEYA from any liability of any injury my child may sustain while participating in any SVEYA activity. In my absence, I give TCYSA permission to provide or obtain medical attention as TCYSA may find appropriate. I also understand that it will be my responsibility to see that my child attends practices and games. I also understand that squared cleats with sharp corners or cone-shaped, pointed cleats are not acceptable footwear for soccer. METAL CLEATS ARE NOT ACCEPTABLE IN TCYSA.</p><p>Parent/Guardian Signature: ______Today’s Date: ______</p><p>May 2016 Paid: * CASH check # Scholarship Rec’d by: Date: </p><p>May 2016</p>