Participant information:

 

First name*
Last Name*
Email*
Birthdate* Calendar
Gender*
F M  
Home Phone*
Address*
City*
Zip*
Parent Name*
T-Shirt Size*
Closed
 
Jean Duluth Field (August Session)
5 PM  
Cloquet St. Paul's Field (August Session)
5 PM 6:15 PM  
I would like to purchase a size 3 soccer ball with my registration.

Adds $7 to cost of registration.

Yes No  
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 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). I hereby release, and/or otherwise indemnify the AYSA, and its affiliated organizations, their employees and contractors, and the owners of fields and facilities utilized for the camp, against any claim by or on behalf of the registrant as a result of their participation in AYSA.

***REFUNDS: Refunds will only be granted if requested more than three weeks prior to the first session date.

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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