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Spring 2012 Registration
Ages 3 - 16 years Old
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WTYSA Spring 2012 Soccer Registration

Please fill out the form below to register your child for our Spring 2012 soccer season. Please fill out a separate form for each child.

MEDICAL RELEASE AND PARENT APPROVAL DISCLAIMER (MUST READ): Since the sport of SOCCER involves aggressive play as well as player contact, injuries may occasionally occur during practice sessions and games. By submitting this form electronically the parent/guardian of the minor named on this form releases and shall indemnify and hold harmless Woodbridge Township Youth Soccer Association from any and all damages that may occur as a result of such injuries. The undersigned also acknowledges and understands that in the event of the possibility of injury, emergency medical assistance may have to be administered. Woodbridge Township Youth Soccer Association requires full disclosure of any and all medical conditions or allergies which may require adverse effect on emergency medical treatment (e.g. drug allergies; diabetes; asthma; reaction to stings; etc). Disclosure shall include any and all medical conditions and/or allergies of the above named minor or minors applying to play soccer with Woodbridge Township Youth Soccer Association.

Please enter as much information as possible when making a request for a player or coach. PLEASE NOTE that no requests can be made for the Silver and Gold Divisions (ages 12-16).

Player Name: *
Player Birthdate (MM/DD/YYYY): *
Male / Female (Please enter M or F): *
Mailing Address: *
City: *
State:
ZIP Code: *
Parent/Guardian #1 Name: *
Parent/Guardian #1 Cell Phone Number: *
Parent/Guardian #1 Email Address: *
Parent/Guardian #2 Name: *
Parent/Guardian #2 Cell Phone Number:
Parent/Guardian #2 Email Address:
Emergency Contact Name: *
Emergency Contact Phone Number: *
Medical Conditions (Enter NONE if none exist): *
Agree to Parent/Medical Disclaimer (Enter Yes if you agree): *
Request(s) (Enter name of coach or player):