RYSC
ROTTERDAM YOUTH SOCCER CLUB
   Rotterdam, NY   USA

    

Travel Tryout Signup Form


Player Information
Please fill in the information for all participating children in your family

Player 1

Player 2
Name:   Name:  
Date of Birth:   Date of Birth:  
Gender:   Male   Female Gender:   Male   Female
Program:   Program:  
Position:   Position:  
Number of years playing recreational soccer:

  Number of years playing recreational soccer:

 
Number of years playing travel soccer:   Number of years playing travel soccer:

 
Player Experience:   Player Experience:  
Other Sports Experience:   Other Sports Experience:  



Player 3

Player 4
Name:   Name:  
Date of Birth:   Date of Birth:  
Gender:   Male   Female Gender:   Male   Female
Program:   Program:  
Position:   Position:  
Number of years playing recreational soccer:

  Number of years playing recreational soccer:

 
Number of years playing travel soccer:   Number of years playing travel soccer:  
Player Experience:   Player Experience:  
Other Sports Experience:   Other Sports Experience:  


Parent/Guardian Name:        
Parent/Guardian Phone:        
Parent/Guardian Cell Phone:        
Emergency Contact Name:        
Emergency Contact Phone:        
Emergency Contact Cell Phone:        

Please indicate player’s special medical/physical condition(s). If no such condition exists, write “NONE”.
If registering more than one child, please use player name & number to indicate which child has a medical condition.


If you have medical insurance, please provide your information below:

     
Insurance Provider:        
Policy Number:
       
 
Parent/Guardian Billing Information
Name:  
Address:  
 
City:  
State:  
Zip Code:  
Email Address :        
Phone Number:        
           
Amount To Charge:        
         
Cardholder Name:        
Card Type:        
Card Number:        
Expiration Date:   /      
         
I understand that soccer is a contact sport and that although efforts will be made to provide safe and orderly practice and game conditions, there will always remain the possibility of serious injury. Recognizing that such risks exist, I give my permission for my child to participate in this activity. I give permission to authorize medical treatment for my child should the need arise. Also, I give my consent to any photos taken of my child can be used on the RYSC website for the purpose of advertising this program.

The RYSC Travel is a competitive program, not a recreational one. When your child becomes part of this
program, a high level of commitment is required of both the players and the parents.

Player placements are based on tryout results, coach’s evaluations and the availability of players and coaches.
Decisions made by the Board of Directors and Coaching Committee are final.

I hereby release the Rotterdam Youth Soccer Club and any of its volunteers from any liability in the event my
child gets injured during the course of the tryout.

I agree to the statements above.

         

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