Richland Area Rotary Youth Soccer

Registration Form

Please Print this document with and follow the directions at the bottom of this introduction page.

Introduction

Children born before 8-1-98  who will not yet be in high school in September 2004 are invited to play in our recreational soccer league this fall. Games will be played on Saturdays from late August through October in Richland Center. Practices will start in mid-August. Players of both genders from age 6 through eighth will be assigned to a team in four divisions according to age. You may choose to have your child placed on a team that practices in Richland Center, Muscoda or Spring Green.

The early registration fee due on or before July 31, 2004.  (Submit separate forms for all players from a single family at one time.) Late registrations will be accepted at a fee of $30 per player between July 25 and August 8, 2004. No registrations will be accepted after August 8, 2004.

Each player will receive a personalized player jersey and be enrolled in the Wisconsin and United States Youth Soccer Associations. Necessary team equipment (i.e. game balls, goals, goal nets, field paint) will be provided by RARYS. Each player will be expected to furnish shorts or sweat pants, appropriate footwear, soccer shin guards and, if possible, a practice ball.

These registration fees cover only direct per-player costs and needed equipment. This program depends on volunteer parental participation in many areas. In order for the league to operate, it is expected that the parent(s) of each player will actively help in one or more of the following areas: COACHING, FIELD PREPERATION, REFEREEING, or CONCESSIONS. We will provide training for those who wish to coach or referee but have no experience. If it is impossible for parents to help due to work or other reasons, an additional contribution of $30 per player is requested in order to hire people to perform some of the needed jobs.

Complete the registration form (a separate one for each child, please) and send with a check in the proper amount, payable to Richland Area Rotary Youth Soccer (or RARYS) to: RARYS Registration, 27117 State Hwy.58, Richland Center, WI 53581 Be sure to indicate which town you prefer for practices and your child’s shirt size.

For further information about the fall league, contact Kim Luckey (608) 647-2637, Pat Magee (608) 585-2418, Chris Reedy (608) 532-6310 or Russ Roske (608) 588-2765, listen to the radio and watch the local papers for announcements.

RICHLAND AREA ROTARY YOUTH SOCCER

REGISTRATION FORM

FALL 2004 SEASON

Last Name: ________________________First Name:______________________Middle Initial:_____

Address:_________________________________________________________________________

City:___________________________State:________Zip Code:___________Email:______________

Phone:____________________Male/Female:_______Birthdate:_____/______/________

Father Last:____________________Father First:___________________Bus. Phone:______________

Mother Last:____________________Mother First:___________________Bus. Phone:_____________

School:______________________Grade Entering:___________Height:_________Weight:__________

Years Played:_______________Last RARYLS Team:_________________Last Year Played:________

Doctor:_________________________________Dr. Phone:__________________________

Emerg. Contact:____________________Emerg Phone:______________________Relation:__________

CHECK ATTACHED IN THE AMOUNT OF: __________________

	1 Player	2 Player	3 Player	4 Players
Regular Fee by 7/25/04	q q$24	q q$44	q q$60	q q$76
Regular Fee w/donation in lieu of Volunteering	q q$54	q q$74	q q$90	q q$106
Late Registration 7-25 through 8/8	q q$30	q q$60	q q$90	q q$120
Late Reg. W/donation in lieu of volunteering	q q$60	q q$90	q q$120	q q$150

Shirt Size: ___YM ____YL ____AS ____AM ____AL ____AXL (sizes run small)

Other Children in Family in RARYSL Preference for Town for Team Practice

_____________________________ ____ Richland Center

_____________________________ ____ Muscoda

_____________________________ ____ Spring Green

_____________________________

Please return registration to:

RARYS Registration, 27117 State Hwy.58, Richland Center, WI 53581

I, the parent/guardian certify that the registrant, a minor, is physically able to participate in soccer and agree that the registrant and I will abide by all the rules of USYSA, its affiliated organization and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for USYSA accepting the registrant for its soccer program and activities (the “programs”), I hereby release, discharge and/or otherwise indemnify the USYSA, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Program, 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.

NAME:____________________________________________________________________________

Parent/Legal Guardian (please print)

Signature:___________________________________________________Date:___________________

List any medical problems or prohibitions player has:

CONSENT FOR MEDICAL TREATMENT (MINOR)

As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care prescribed 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 or well being of my dependent.

Signature of Parent or Guardian

PARENTAL SUPPORT

As a volunteer based organization, we request active participation of all parents in our program in order to keep costs down. We will try to accommodate your requests for assignments but cannot guarantee them in all cases. Please check the box next to your preference below:

COACH	SITE COORDINATOR
REFEREE	CONCESSION STAND
FIELD PREP – will require Fri Night or Early Saturday
$30 DONATION IN LIEU OF VOUNTEERING AS MARKED ON FRONT