TARPON SPRINGS YOUTH SOCCER ASSOCIATION
PLAYERS REGISTRATION FORM

Player Name ___________________________________________________________
                       Last Name  First Name Initial

Phones _________________________________________________________________
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Address _________________________________________________________________

City ____________________________________________________ Zip _________

Gender ___ Birth Date ___________ Verify ___ HS Grad Year ______ Citizen ____

E-mail Address___________________________________________________________

Parent/Guardian Name _________________________________________________

INFORMED CONSENT/INSURANCE NOTICE
FYSA RECOMMENDS THAT PLAYERS NOT REGISTER TO A TEAM WHOSE AGE GROUP EXCEEDS THE PLAYER’S NORMAL AGE.

INSURANCE NOTICE: All injuries must be reported within 90 days of the date of the injury

INFORMED CONSENT: I the parent/guardian of the registrant, agree that we will abide by the rules of (TSYSA), the state association (FYSA) and all its affiliated organizations. My/Our child wishes to participate in soccer during the season of this registration. I/We realize risks are involved in my/our child’s participation. I/We understand that the risk to my/our child includes full range of injuries from minor to severe, and the result could be death, paralysis, or other serious permanent disability. I/We accept this risk as a condition of my/our child’s participation.
Parent/Guardian Signature___________________________ Date ________________

Players Pass No. __________ Rec. Card # __________ Shirt Size _____ Shorts _____

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Complete this section ONLY if this form will be sent to the FYSA office to register the player
District ____ C2 ____ Club ___ TSS ____ Team Code _____________ League ________

Registrar Signature ____________________________________ Date ____________

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