Player Information

*PLYSA League: Tiny T-Ballers Lil' Kickers Soccer Flag Football Cheer

*First Name:

*Last Name:

*Address:

*City:

*State: Zip Code:

*Phone Number:

School: Grade:

*Birthdate: Male Female

Parent or Guardian information

Parent/Guardian 1

*Email Address:                                                            

* Name:

*Home Phone:         

Cell Phone:             

Parent/Guardian 2

Name:

Home Phone:

Cell Phone:

League Policies

Please check all the boxes below. By checking the boxes you agree that you have read, understand and agree to the terms listed. You must check all boxes to proceed.

I/We, the parent/guardians of the above-named player hereby give my/our approval to participate in any and all PLYSA activities. 

Please Check

I/We know that participation in sports and recreation activities may result in serious injuries and protective equipment does not prevent all injuries to players, and do hereby waive, release, absolve, indemnify, and agree to hold harmless the PLYSA, the organizers, sponsors, supervisors, participants, the board members, and persons transporting my/our child to and from activities from any claim arising out of any injury to my/our child whether the result of negligence or for any other cause.

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I/We agree to provide proof of legal residence and age. I/We understand that our child must be eligible under residence regulations of the PLYSA to participate in the PLYSA and that if any controversy arises regarding residence and/or age, the decision of the PLYSA Board shall be final and binding.

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I/We will furnish a certified Birth Certificate of the above-named candidate to League Officials upon signing up and upon request.

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I/We understand that unwelcome behavior of parents, such as voicing loud uncomplimentary opinions of umpires, managers or players, smoking and/or drinking alcohol, fighting or provoking a fight is not condoned at PLYSA games and can be cause for player and/or parent/guardian expulsion from PLYSA field grounds.

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I/We will make every effort to make my/our presence at the games and practices a source of encouragement for the players, volunteer managers/coaches, and volunteer umpires, and not subject them to harsh criticism.

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I/We understand the importance of parent involvement in this volunteer program and will do my/our part to lend a hand in fund raising, facility maintenance, snack bar labor, and other areas where our help is needed.

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I/We agree to allow the use of our childs pictures on thePLYSA website and otherPLYSA advertisements and publications.

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Please check any other volunteer positions that interest you:

  Manager(v)/ Coach(v)/  Team Parent(v)/

Field & Park Maintenance/ Clean Up Days/

Other

(v) Denotes a Volunteer Application is required.

Medical Release & Consent for Treatment

Parent or Guardian Authorization:

In case of emergency, if family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician)

*Family Physician:

*Phone:

*Address:

Hospital Preference:

In case of emergency contact:

Name:

Phone:

Relationship to Player:

Name:

Phone:

Relationship to Player:

Medical History

Please list any allergies/medical problems, including those requiring maintenance medications. (i.e. Diabetes, Asthma, Seizure Disorder)

Date of last Tetanus Toxoid Booster:

The purpose of the above listed information is to ensure that medical personnel have details of any medical problem, which may interfere with or alter treatment.

Warning: Protective equipment cannot prevent all injuries a player might receive while participating in sporting and recreational activities.

You will be required to sign a Consent for treatment form in person before your child will be eligible to play. This may be done at the first practice or meeting.

Additional Comments:

By clicking on the submit button below, you agree that you are the above childs legal parent/guardian and that you agree to all the terms indicated.