EASTERN PENNSYLVANIA YOUTH SOCCER ASSOCIATION FALL REGISTRATION FORM

EASTERN PENNSYLVANIA YOUTH SOCCER ASSOCIATION 2008-2009 REGISTRATION FORM
This portion for EPYSA

ID: XXX (no longer needed)	Manheim Township Soccer Club 08MTW State: 04 District: 08
2008-2009 Age Division U- *	Played 2007-2008 Yes No League Code: __________

Last Name : *	First Name : *	M.I.:
Address: *	Telephone: * (inc. Area Code)
City: *	State: *	Zip.: *

Birth Date: * Sex: M F * Parent / Guardian Name: *

RELEASE STATEMENT

I, the parent/guardian of the registrant, a minor, or adult registrant of legal age, agree that I and the registrant will abide by the rules of the Manheim Township Soccer Club(MTSC) and the EPYSA, it's affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the MTSC and EPYSA accepting the registrant for its soccer programs and activities(the "Programs"), I hereby release, discharge and/or otherwise indemnify the MTSC and EPYSA, it's 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 the registrant as a result of the registrant's participation in the Programs, and/or being transported to or from the game, which transportation I hereby authorize.

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You must enter your initials in the box above to signify that you have read the above statement and you agree to its terms.

MANHEIM TOWNSHIP SOCCER CLUB 2008-2009 REGISTRATION FORM
This portion for Coach
Girls Boys *

Under 9 - 8/1/99 to 7/31/00	Under 10 - 8/1/98 to 7/31/99
Under 11 - 8/1/97 to 7/31/98	Under 16 - 8/1/92 to 7/31/93
Under 12- 8/1/96 to 7/31/97	Under 17 - 8/1/91 to 7/31/92
Under 13 - 8/1/95 to 7/31/96	Under 18 - 8/1/90 to 7/31/91
Under 14 - 8/1/94 to 7/31/95	Under 19 - 8/1/89 to 7/31/90
Under 15 - 8/1/93 to 7/31/94

Played MTSC Travel Before Played Travel Elsewhere Never Played Travel
Participant's Name: *
What do you want the coach to call you *
Dad's Name:
Dad's Address:
Players Address? Yes No
Dad's Home Phone: Dad's Work Phone:
Mom's Name:
Mom's Address:
Players Address? Yes No
Mom's Home Phone: Mom's Work Phone:
Parent to contact for soccer Mom Dad Either

CONSENT FOR MEDICAL TREATMENT (MINOR)
As the parent or legal guardian of the above named
player I hereby give my consent for emergency medical care
provided by a duly licensed Doctor of Medicine or

Doctor of Dentistry. This care may be given under
whatever conditions are necessary to preserve the life,
limb or well being of my dependent.
I VERIFY THAT ALL INFORMATION IS TRUE AND
ACCURATE. I UNDERSTAND THAT INTENTIONALLY
SUBMITTING UNTRUE/FALSE INFORMATION COULD
LEAD TO ELIGIBILITY DISQUALIFICATION, THE
DURATION TO BE DETERMINED BY THE EXECUTIVE BOARD OF THE MTSC.***
You must enter your initials in the box above to signify that you have read the above statement and you agree to its terms.

If you are trying out for an age group above your age, you must sign this waiver form.
WAIVER AND REQUEST FOR PLACEMENT OF
OF A PLAYER IN AN OLDER AGE GROUP
At my request, he/she will be placed on a team and in a league made up of predominately older children than the team/league
within which my child would normally participate. Consequently, I recognize that he/she may experience an increased risk of
increased risk of injury as a result of competing with children
who are likely to be heavier, faster, and stronger, than
children in the age group that my child would normally participate in. On behalf of my child, I hereby release and
promise to indemnify the Manheim Township Soccer Club, Inc., Lanco Youth Soccer League, E.P.Y.S.A., and all coaches
referees, and other adults involved in the soccer program from any liability or responsibility for any injury which my child may
suffer as a refult of or which was contributed to by his/her participataion in the older age gorup.

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You must enter your initials in the box above to signify that you have read the above statement and you agree to its terms.

This form must include players Social Security Number and two signatures - three if requesting a waiver to play up.

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