The Balls Mills Soccer Club
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RG-6
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Indicates required field
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Player
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NCP 13
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Balls Mills Soccer Club
Age Group
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U10 Girls
U11 Girls
U12 Girls
U13 Girls
U15 Girls
U18 Girls
U10 Boys
U11 Boys
U12 Boys
U13 Boys
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Coach's Name
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Player Information
Name
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First
Last
Street/Apartment Address
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City
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State
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PA
Zip Code
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Township/Borough
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County
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Birth Date
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Gender
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Male
Female
HAS THIS PLAYER BEEN ROSTERED TO A TEAM IN ANOTHER USYSA ORGANIZATION IN THE PREVIOUS SOCCER YEAR?
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No
Yes
IF YOU SELECTED
YES
TO THE PREVIOUS QUESTION, THE PLAYER IS CONSIDERED A
TRANSFER
. YOU MUST PROVIDE THE FOLLOWING INFORMATION ABOUT THE PLAYER’S ID ON THE PREVIOUS 2012-13 TEAM.
State Association
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Out of State Player ID
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DOES THE PLAYER HAVE AN AUTHORIZED AND COMPLETED RELEASE DOCUMENT FROM HIS/HER TEAM APPROVED BY THE PREVIOUS USYSA STATE ASSOCIATION IN WHICH HE/SHE WAS ROSTERED?
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Yes
No
DID THE PREVIOUS TEAM COMPETE IN A 2012-13 STATE CUP COMPETITION?
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No
Yes
Parent Information
Name
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First
Last
Email
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Phone Number
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Cell Phone Number
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Release Statement
NOTE:
This Statement MUST be signed by Parent/Guardian for Minor Player; an Adult Player for him/herself; Coach for him/herself; and Administrator for him/herself.
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 EPYSA, and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the EPYSA accepting the registrant for its soccer programs and activities ("the Programs"), I hereby release, discharge and/or otherwise indemnify the EPYSA, its 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 of the registrant as a result of registrant’s participation in the Programs, and/or being transported to or from the same which transportation I hereby authorize.
Electronic Signature (Please Type in Full Legal Name)
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I certify that all above information is true to the best of my knowledge.
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Yes
No
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