WESTFIELD YOUTH SOCCER ASSOCIATION

P. O. Box 1564

WESTFIELD, MA 01086-1564

LATE REGISTRATION FORM

Player’s First Name: ______________________________________________

Player’s Last Name: ______________________________________________

Player:        Male _____      Female _____

Player’s Date of Birth: __________________________________

Address: _____________________________________________

City: _______________________________

Parent Phone Number: ______________________

Parent Cell Phone: _____________________

Parent Email Address: __________________________________

Please mail in this form along with the following:

1. A check or money order made out to Westfield Youth Soccer for $60.00 per child.

2. A  copy of a birth certificate if you did not play for WYSA last season. 

Please sign below. 

I, the parent of the above named candidate for a position on a Westfield Youth Soccer team, hereby give my approval to participate in any and all soccer activities.  I assume all risks and hazards incidental to such participated including transportation to and from the activities, and I do hereby waive, release, indemnify and agree to hold harmless the Westfield Youth Soccer Association, the organizers, sponsors, supervisor, participants and persons transporting my child to and from activities, for any claim arising out of an injury to my child, whether the result of negligence or for any other cause.

Signature of Parent ______________________________________________________________

Please Print Parent Name Here_____________________________________________________