Player Registration Form – Fill Out and Use This PDF

WPL Player Registration Form

Please print legibly and sign the form at the bottom.

2009 WPL Player Registration Fee is $35 per player

Team and Club Information

League Name __________________________________________________ Division ____________________

Club/Team Name ____________________________________________________________________________

Region 02 State WI Team Manager __________________________________________________________

Player Information

Last Name____________________________________ First Name ___________________________________

Address ____________________________________________________________________________________

City ________________________________ State___________ Zip __________________________________

Telephone ___________________________ Date of Birth ____________ □ Male

T-shirt size: Small Med Large Current school/college or club affiliation : ____________________________

________________________________________________________________________

Parent or Guardian Information

Father’s Name_________________________________	Alternate Phone _______________________________
Mother’s Name ________________________________	Alternate Phone _______________________________

List any medical problem or prohibition player has _________________________________________________

Person to notify in emergency ____________________________ Phone _______________________________

Doctor to notify in emergency ____________________________ Phone _______________________________

Important

I, or the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the WYSA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the WYSA accepting the registrant for its soccer programs and activities (the ”Programs”), I hereby release, discharge and/or otherwise indemnify the WYSA, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the programs and/or being transported to or from the same, which transportation I hereby authorize.

Player Signature _________________________________________________ Date _______________

Parent or Guardian Signature _______________________________________ Date _______________

Helping Wisconsin’s Youth Hit Their Goals

10201 West Lincoln Ave. Suite 207 West Allis, WI 53227-2027

Tel: 888-328-9972 Fax: 414.328.8008 Web site address: www.wiyouthsoccer.com

2009 WPL Player Reg.doc