Primary Phone: ________________________ Secondary Phone:____________________
Player Gender: ____ Male _____ female
School:___________________________________
Mother’s Name/Legal Guardian_________________________________ Email: _________________
Address: _________________________________City_____________________ Zip________
Primary Phone: ________________________ Secondary Phone:_______________________
Father’s Name/Legal Guardian_________________________________ Email: _________________
Address: _________________________________City_____________________ Zip________
Primary Phone: ________________________ Secondary Phone:_______________________
I, the parent/guardian of the registrant, a minor, agree that the registrant(s) and I will abide by the rules of the USYSA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the USYSA accepting the registrant for its soccer programs and activities (the Programs), I hereby release, discharge, and/or otherwise indemnify the USYSA, its affiliated organizations and sponsors, their employees an associated personnel, including the owners of the fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant(s) as a result of the registrant(s)'s participation in the Programs and/or transported to or from the same, which transportation I hereby authorize.----_____Initials
Consent for Medical Treatment (Minor):
As the parent or legal guardian of the above named player(s), I hereby give my 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, limb, or well being of my dependent(s). ---_____ Initials
Conduct of Discipline Policy:
As the parent or legal guardian of the above named player(s), I agree that I and the registrant(s) as a TOPSoccer parent/player will:
• Provide transportation to and from all practices/ games, ensuring that the player is prompt.
• Attend all practices and games.
• Lend support in a positive manner.
• Provide any pertinent information about your child to the coaches and administrators
https://www.angelfire.com/planet/middletntopsoccer/-----_______ Initials
Signature of Parent or Legal Guardian ___________________________________ Date_____________
Please send registration form to :
Middle Tennessee TOPSoccer
Attn: Jennifer Teague
1453 Mayberry Lane
Franklin, TN 37064-9613
I __________________ DO give my permission to Middle Tennessee TOPSoccer for my child ___________________ to use their name for photo and/or media release.
I __________________ DO NOT give my permission to Middle Tennessee TOPSoccer for my child’s name to be used for any or all photo and/or media releases.
This photo and/or media release is good for one year. You will have to update a new one each year that you sign your child up for soccer. Everyone’s name will be in strict confidence of the staff of Middle Tennessee TOPSoccer.
________________________________________ ________________
Parent’s signature Date
________________________________________________________________________________
Emergency Contact___________________________ Relation to player:________________
*Someone other than mother or father. This is used in case we cannot contact one of the parents
Primary Phone: ________________________ Secondary Phone:________________
Uniforms (New Player only or you need new uniform due to growth or being worn out/lost/usage.) :
We have new uniforms this year that will be provided to all TOPSoccer players at no cost to the players. Please indicate uniform size:
Socks: YL YM YS Shorts: YL YM YS Jersey: YL YM YS AS AM AL AS AM AL AS AM AL
Player Profile:
Played previously ( Please check all that applies):
____ Local Recreation League ( i.e. YMCA,Church) ____ Special Olympics
_____ TOPSoccer ______ Other recreational sports ( basketball, swimming)
Independence:
______ My child won’t need a “buddy” on the field.
______ My child will be “buddied” by ____________________ relationship to player is: ___________________________
______ We would like to have a volunteer “buddy” assigned to my child.
Strengths (New Players to our program or changes we need to know for your child) :
What are your child’s areas of strengths as it pertains to athletics?_______________________
________________________________________________________________________________
________________________________________________________________________________
In what areas would you like to see improvement?_______________________ ________________________________________________________________________________ ________________________________________________________________________________
Does your child use a wheelchair or walker? Wheelchair Walker Neither
Briefly describe your child’s physical or medical condition ?_______________________ ________________________________________________________________________________ ________________________________________________________________________________
What are some motivational techniques that would help your child?_______________________ ________________________________________________________________________________ ________________________________________________________________
