Birth Year Guidelines

NYSA Player Registration Form

NYSA REGISTRATION FORM
2010 SEASON

Please complete form below to register. Fields marked with a "*" are required. When you finish, click on SUBMIT and follow the anti-spam cyber security measures.

2010 PARTICIPATION FEE
$160

The participation fee for the NYSA soccer 2010 season is $160. You can pay this fee online using PayPal after you have completed the registration form below. If you are going to write a check, please make it out to Northwoods Youth Soccer Association and mail it to
NYSA Registrar
PO Box 115
Grand Rapids, MN 55744

MEDICAL REFUND

If BEFORE the 2010 Spring season starts, an NYSA player cannot participate due to a medical reason, NYSA will return a partial refund. Please provide a doctor's note.

First Name

Middle Initial

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Player e-mail

Birth Date

PARENT/GUARDIAN 1 FIRST NAME

Parent/Guardian 1 Last Name

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Cell Phone

Parent/Guardian 1 E-mail Address

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 E-mail

Person to notify in emergency

Phone of Person to Notify in Emergency

MEDICAL INFORMATION & CONSENT

Doctor

Clinic

Clinic Phone

Hospital

Medical Insurance

Dentist

Dental Insurance

Dentist Phone

MEDICAL RELEASE: As the parent or legal guardian of a participant in the USYA/MYSA/AYSA/NYSA programs, I give consent for emergency medical care by a duly licensed Doctor of Medicine or Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.

AGREEMENT: I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the United States Youth Soccer Association (USYSA), the Minnesota Youth Soccer Association ( MYSA), the Arrowhead Youth Soccer Association (AYSA), Northwood Youth Soccer Association (NYSA), and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the USYSA,MYSA,AYSA,NYSA,accepting the registrant for its soccer programs and activities, I hereby release, discharge, and/or otherwise indemnify the USYA,MYSA,AYSA,NYSA, and its affiliated organizations, and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.

Parent/Legal Guardian

Registrant

Parent/Legal Guardian Initials

Registrant Initials

Today's Date

VOLUNTEER OPPORTUNITIES: The success of NYSA depends on the active participation of adults. Please select the area(s) you are willing to help with.

Area to help

Coach

Assistant Coach

Team Parent

Referee

Board Member

Other

If the information above is all correct, please click "SUBMIT REGISTRATION" to continue. Payment is the next and final step. You can either mail a check to NYSA or pay online with PayPal.

NYSA Player Registration Form

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