Thomaston Youth Soccer Association Registration Form :
Name : ___________________   Male [  ]
Female [  ] 		     DOB __/__/__     Grade Fall '08  [   ]
Address : ___________________   Interested in Travel Team :
Yes [  ]  No [  ] 		School ________
City/Town : ___________________   Willing to volunteer your time : Jamboree
Yes [   ]  No  [  ] 
State : ___________________   Willing to volunteer your time : Team Parent
Yes [   ]  No  [  ]
ZipCode : ___________________   Shirt Size:_______
Phone : ___________________   SSN :__________________
I/We _____________________________________, the parents of the above named candidate
for a position on a Thomaston Youth Soccer Team, hereby give my/our approval to participate in any
and all Thomaston Youth Soccer activities, including transportation to and from the activities.

I/We know that participate in soccer 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 Thomaston Youth Soccer Association, the Connecticut Junior Soccer Association,
the sponsors, supervisors, participants and person transporting my/our child to and from the activities
for any claim arising out of any injury to my/our child, whether the result of negligence or for any
other cause, except to the extent and in the amount covered by accident or liability insurance.

I/We will furnish a certificate birth certificate  of the above named candidate to Thomaston Youth
Soccer officials if requested. I/We agree to return upon request the uniform and any other equipment
issued to my/our child in as good a condition as when received except for normal wear and tear.
I/We understand that my/our liability for failure to return any issued uniforms and/or equipment
will be the prevailing replacement cost of those items.

In case of emergency, if family physician cannot be reached, I//We  hereby authorize my/our
child, named above, to be treated by another qualified, licensed physician who is available.
Family Physician Name ______________________ Phone Number : __________
Address ______________________
City/Town ______________________ State : ____ Zip : ______
Indicate physical limitations (allergies, hearing, site, etc.) :__________________________
In case of emergency contact : __________________________  Phone : ____________
Medical Insurance Plan : _______________________         ID Number : ____________
Parent or guardian Signature : ______________________            Date : ___/___/_____

JEWELRY NOTICE TO PARENTS -
According to CJSA regulations, soccer players are NOT ALLOWED to wear any jewelry while playing soccer.
If your child has pierced ears or is wearing any other type of jewelry, they will be required to remove it before
they will be allowed on the playing field. THERE ARE NO EXCEPTIONS. This rule will be strictly enforced.

I have read the above notice and will adhere to these rules : ___________________  (Please initial)