Gallatin Co Youth Sports Association
Sports Registration Form
P.O. BOX 644
WARSAW KY 41095
SOCCER FEES $10
Please only 1
child per registration form. Make additional copies as needed.
Players are only allowed
to play on one team. Birth certificates may be required per age group.
LAST NAME_____________________________FIRST
NAME_________________________MI____
ADDRESS________________________________CITY_______________ST__________ZIP________
PHONE (HOME)
____________________________OTHER____________________________
E-MAIL_____________________________________
FATHERS
NAME______________________________MOTHERS NAME_______________________
GRADE ______ Uniform Size________________________ Previous
Coach__________________
BIRTHDATE ____________________ HOW OLD WERE YOU ON August 1ST____________
List any medical
conditions______________________________________________________________________
Name of Child
: _______________________________________________________________
The Child above has my
permission to participate in Gallatin Co Youth Sports Association activities. I
hereby release GCYSA from any liability for injury or loss that may result from
such participation. I also understand that this is a
recreational sport and any unsportansmanlike
behavior will not be tolerated from players or parents. Coaches will also have
the right to dismiss a player from the team for offensive behavior at practice
or a game. Coaches will also be responsible for parents
behavior, so remember you are here for the children.
Furthermore, I have been
given a copy of the Code of Conduct.
Parent/Guardian
Signature____________________________________________________Date_____________________
MAKE CHECKS PAYABLE TO: GCYSA,
IF
YOU NEED ANY ADDITIONAL INFORMATION PLEASE CALL 643-2556
FOR REGISTRAR PURPOSES ONLY
PAYMENT RECEIVED: _________________________AMOUNT______________________CHECK#_______________________
ASSIGNED TO __________________________________________________
Fees are to help with expenses to run
the sport.
Please remember we will keep cost for
all sports to a minimum .