R002 Y Form PDF Details

The R002 Y form serves a critical role in the registration process for young athletes looking to participate in US Club Soccer programs. Designed to be submitted to a player's home team club, it acts as a comprehensive Youth Player Registration Form, encompassing several key components necessary for the successful enrollment and participation of young players in soccer activities. This document not only facilitates the registration with a specific club but also stipulates that the form should be held by the club for a minimum of five years or until the player reaches the age of 18, whichever is later. It includes crucial sections such as the player's medical information, a medical treatment authorization, and a liability waiver, which are pivotal in ensuring that players receive appropriate care and treatment in the event of an injury, and that the club, along with US Club Soccer and other affiliated organizations, are safeguarded against potential claims. Furthermore, it outlines the conditions under which a player can register with a club, emphasizing that a player may only be registered with one US Club Soccer member club at any time, thereby ensuring a structured and regulated participation framework. This form lays down a solid foundation for the administrative, legal, and safety aspects of youth soccer participation in the US, making it an indispensable document for clubs, players, and parents alike.

QuestionAnswer
Form NameR002 Y Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesyouth soccer registration form, us soccer registration form, us club player registration, us club medical release form

Form Preview Example

This form should be submitted to your home team’s club.

YOUTH PLAYER REGISTRATION FORM

This form must be retained by the club for at least five (5) years or he player’s 18th birthday, whichever occurs last.

Club Name:

City:

State:

League Name:

 

 

 

 

 

I hereby consent to the above-named club registering me with US Club Soccer. I understand that I may be registered to only one US Club Soccer member club at any time. [Note: it will not be necessary to complete this form again as long as the player is with this club, which will hold this form unless requested by US Club Soccer.]

___________________________________

_____________

________________________________

_____________

Player’s Signature

Date

Parent/Guardian Signature

Date

 

 

 

 

PLAYER’S MEDICAL INFORMATION

Player’s Name:

 

Birth Date:

Gender:

 

Female

Male

 

 

 

 

 

 

 

 

 

Street Address:

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

 

State:

Zip :

Email Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Parent Name:

 

Home Phone:

(

)

Bus Phone:

(

)

 

 

 

 

 

 

 

 

 

 

Email Address:

 

Cell Phone:

(

)

Receive texts?

 

Yes

No

 

 

 

 

 

 

 

 

 

Parent Name:

 

Home Phone:

(

)

Bus Phone:

(

)

 

Email Address:

Cell Phone:

(

)

Receive texts?

Yes

No

In an emergency when parent/guardian cannot be reached, please contact the following:

Name:

Phone 1:

(

)

Phone 2:

(

)

 

 

 

 

 

 

 

Name:

Phone 1:

(

)

Phone 2:

(

)

 

 

 

 

 

 

 

Please list Allergies the player has:

 

 

 

 

 

 

 

 

 

 

 

 

 

Please list other medical conditions:

 

 

 

 

 

 

 

 

 

 

 

 

 

Physician

Phone 1

(

)

Phone 2

(

)

 

 

 

 

 

 

 

Medical/Hospital Insurance Company

 

 

 

Phone

(

)

 

 

 

 

 

 

 

Policy Holder’s Name

 

 

 

Policy Number

 

 

 

 

 

 

 

 

 

MEDICAL TREATMENT AUTHORIZATION AND LIABILITY WAIVER

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.

Signature_____________________________________ Date ____________ Relation to player:

Father

Mother

Guardian

Form #R002-Y – 5/2012

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Stage number 1 in filling out us club player registration

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us club player registration completion process detailed (stage 2)

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