Player Registration Form 2008 Outdoor Season

Contact Information:

Players Name:

Address:            City:                Postal Code:

Phone Numbers:    Home:            Parents at Work:(Mother)    (Father)

                            Mothers Cell Phone:    Fathers Cell Phone:

E-Mail Address:

Player Information:

Gender:    Male    Female

Birth Date:

Hospitalization Number:

Player Medical Information:

Contact in Case of an Emergency:            Phone:        Relationship:

Alternate Contact:        Phone:        Relationship:

Family Doctor:        Phone:

Medications:

Allergies:

Previous Injuries:

Does Player carry and know how to administer his/her own medicine?    Yes    No

Other (braces, contact lenses, etc):

Liability Waver Release:

The goal of the Yorkton United F.C. is to provide the opportunity for as many qualifying players as possible to enjoy the experience of playing soccer. Keeping with this goal, the Yorkton United F.C. has set forthe the above policies and by signing the registration form, you agree to these policies. In addition, the undersigned Player/Parent/Guardian acknowledges that playing soccer is an activity, which includes risks, which can result in physical injury under normal playing conditions. The undersigned consents to him or herself, or his or her child participating in the soccer programs of the Yorkton United F.C. The undersigned releases the Yorkton United F.C.its directors, Offices, Agents or Representatives with respect to any claims, damages, liability arising from physical injury sustained by him or herself, or his or her child while participating in Club sponsored or supervised activities.

I acknowledge that I have read this document and understand it.    Yes

The following information is used to assist in team selection. All players will be subject to team trades as deemed necessary by Yorkton United F.C.based on an assessment of team fairness after two weeks of regular scheduled season play.

Soccer Experience:

Recreational:    # of seasons played    Indoor:    Outdoor:

Competitive:    # of seasons played    Indoor:    Outdoor:

Once you hit submit this form will be sent by email.

However, Please print a copy of this form and drop off with your fees at Benno's Fitness @ 44 1st Ave N

~Postdated cheques will be accepted~

For office use only:

Cash or Cheque Enclosed: #                         Auth:                                Total Due:                       

Prices include Sask Soccer Registration Fees, Field Levy Fees and Club Registration Fee