FRANKLIN LOCAL YOUTH SOCCER

Fall 2013 Registration Form - *PLEASE PRINT LEGIBLY* Name: Birthday:

Franklin Local Youth Soccer PO Box 23 Duncan Falls, OH 43734 www.facebook.com/flysoccer

Age on 8/1/2013: Sex:

(6U - 8U - 10U - 12U) (Circle One)

Division: Experience:
(Circle One)

Beginner
(First year)

Intermediate
(2 - 3 years)

Street Address: Home Phone: Mother/Guardian: Father/Guardian: School Attending: Please list any medical/mental problems or restrictions coaches should be aware of: Emergency Contact:
(Other than above)

City/State: Email Address: Cell Phone: Cell Phone: Teacher:

Phone: Y-SM
(6-8)

Shirt Size:
(Circle one)

Y-MD
(10-12)

Y-L
(14-16)

Adult Sizes:

SM

MD

# Preference:
(If Any) (1st Choice) (2nd Choice)

Parental Support/Volunteer:
(Circle all that apply)

Coaching

Assistant Coaching

Concession Help

Field Maintenance

Fundraising Help

Consent: The undersigned consent and agree that the above named child may become a member of the Franklin Local Youth Soccer League. In consideration of recreat instruction being furnished, I/we do hereby assume all risks in connection with participation in said activities, and release and discharge FLYS, it's trustees, officers, and m from all claims, demands and damages for injuries to persons and damages to property which may befall the herein named child while participating in such activities, inclu risks connected therewith, whether foreseen or unforeseen; and further to save and hold harmless said league and persons from any claim by me , or by my child, arising o childs participation in such activities. Also, I do hereby give my consent for emergency medical treatment for the above named child. This care may be given under w conditions are necessary to preserve the life, limb or well-being of my dependent. The undersigned agrees to furnish, upon demand, a birth certificate for the participant permission to use photos of the participant and themselves to be used for advertising, i.e. Facebook, websites etc. The undersigned has read, understands and agrees to fo FLYS Parent's Code of Conduct. For more information about the FLYS league, visit our website. www.leaguelineup/flys "Like" us on Facebook. www.facebook.com/flysoccer

/ Parent(s) or Guardian(s) Signature Registration fees are due at time of registration: $40.00 - 1st child Please make checks payable to: Franklin Local Youth Soccer $30.00 - each additional child

Refund policy: No refund is available once your child is placed on a team. There is a $10.00 administrative charge on requested refunds prior to team placement. You will r full refund, if we are unable to place your child on a team this season. There will be a $25.00 return check fee on all returned checks, and that child will not play until the paid. For government assisted families, please inquire about reduced rates.

*For League Use Only Fees Paid Y Amount $ Check Number

N or Cash

Notes:

YOUTH SOCCER

- *PLEASE PRINT LEGIBLY* Grade child is going into: Age on 8/1/2013: M Advanced
(3+ years)

Zip:

LG

XL

(3rd Choice)

Referee

Sponsoring

outh Soccer League. In consideration of recreation and and discharge FLYS, it's trustees, officers, and members d child while participating in such activities, including all from any claim by me , or by my child, arising out of my named child. This care may be given under whatever demand, a birth certificate for the participant and give ersigned has read, understands and agrees to follow the www.facebook.com/flysoccer

book.

Date

0.00 - each additional child

ted refunds prior to team placement. You will receive a ed checks, and that child will not play until the fees are