Participant information:

 

First name*
Last Name*
Email*
Birthdate* Calendar
Gender*
F M  
Home Phone*
Address*
City*
State*
Zip*
Parent Name*
Program Choice*

Choose Program Choice From Dropdown. Program Fee is $65.

T-Shirt Size*

Please choose a T-Shirt size

Medical Information & Consent-*

Alternate who can be notified in emergency

Phone*
Clinic
Medical Insurer

*include policy#

Dentist's Phone
Dentist
Any medical concerns or limitations
I request to play with one of these players

(list up to three)

Parents:

If you would like to coach a team, please enter your name here

I agree with the terms below*

*Yes is required to register

AGREEMENT: I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Arrowhead Youth Soccer Association (AYSA) and the Duluth Area Family YMCA.  I hereby release, and/or otherwise indemnify the AYSA, the Duluth Area Family YMCA, and its affiliated organizations, and their employees and contractors against any claim by or on behalf of the registrant as a result of their participation in the indoor soccer program.   
CANCELLED SESSIONS: Sessions may be cancelled due to dangerous weather.  Cancelled sessions may or may not be made up at the
discretion of program organizers.  No refund will be provided for sessions cancelled due to weather.   REFUNDS: Refunds are only given if Medical Conditions, confirmed by a doctor's note, prevent participation.
MEDICAL RELEASE: As the parent or legal guardian of a participant in the AYSA program, I give consent for emergency medical care by a duly licensed Doctor of Medicine or Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.

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