PYSA

PERRYSBURG YOUTH SOCCER ASSOCIATION REGISTRATION

2023 Spring Season
Registration opens: January 13 - February 28
Late registration: March 1 - March 13
Games: April 15 - May 20

Number of Players to Register*

Child One

Name of Player*

First Last

League of Player*

Coed PreK
Coed Kindergarten
Girls 1st-2nd
Boys 1st-2nd
Girls 3rd-4th
Boys 3rd-4th
Girls 5th-8th**
Boys 5th-8th**
Coed 9th-12th***

**Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
***Coed 9th-12th plays against other community soccer leagues have games on Saturdays and some Sunday afternoons. 7th and 8th graders may choose to "play up" to this league.

Gender*

Date of Birth*

School*

School Grade*

Player’s current school grade or grade they will be enrolled in during the soccer season.

Has player participated in an organized soccer league before?*

YES
NO

Number of soccer seasons played

Fall and Spring are considered separate seasons

Player’s Coach Preference (optional)

We will try our best to accommodate your request depending on availability.

Player’s Practice Preferences

Please list any practice days (M-Th) and times (5p-8p) that player is not available. This information is used to create teams and practice schedules. You may also include player’s preferred practice days and times as well. We will try our best to accommodate your request.

PreK T-shirt*

All PreK league players receive a free t-shirt with registration. One size only (Youth XS); yellow shirt with black “PYSA” text printed on the front. This section is to allow players who may already have a PreK t-shirt (and do not want to receive another one) to opt out of receiving one.

Yes, I want a PreK t-shirt
No, I do not want a PreK t-shirt

Black/Yellow Reversible Jersey ($25.00)*

Yes, I want a new reversible jersey
No, I already have a reversible jersey or will find one elsewhere

All leagues K-8th grade use this jersey for games

Black/Yellow Reversible Jersey Size*

Medium 10-12 (YOUTH)
Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Yellow w/ Black Non-Reversible Jersey ($25.00)*

Coed 9th-12th league players use this jersey for games

Yes, I want a Coed 9th-12th league non-reversible jersey
No, I already have this jersey or will find one elsewhere

Yellow w/ Black Non-Reversible Jersey Size*

Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Child Two

Name of Player*

First Last

League of Player*

Coed PreK
Coed Kindergarten
Girls 1st-2nd
Boys 1st-2nd
Girls 3rd-4th
Boys 3rd-4th
Girls 5th-8th**
Boys 5th-8th**
Coed 9th-12th***

**Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
***Coed 9th-12th plays against other community soccer leagues have games on Saturdays and some Sunday afternoons. 7th and 8th graders may choose to "play up" to this league.

Gender*

Date of Birth*

School*

School Grade*

Player’s current school grade or grade they will be enrolled in during the soccer season.

Has player participated in an organized soccer league before?*

YES
NO

Number of soccer seasons played

Fall and Spring are considered separate seasons

Player’s Coach Preference (optional)

We will try our best to accommodate your request depending on availability.

Player’s Practice Preferences

Please list any practice days (M-Th) and times (5p-8p) that player is not available. This information is used to create teams and practice schedules. You may also include player’s preferred practice days and times as well. We will try our best to accommodate your request.

PreK T-shirt*

All PreK league players receive a free t-shirt with registration. One size only (Youth XS); yellow shirt with black “PYSA” text printed on the front. This section is to allow players who may already have a PreK t-shirt (and do not want to receive another one) to opt out of receiving one.

Yes, I want a PreK t-shirt
No, I do not want a PreK t-shirt

Black/Yellow Reversible Jersey ($25.00)*

Yes, I want a new reversible jersey
No, I already have a reversible jersey or will find one elsewhere

All leagues K-8th grade use this jersey for games

Jersey Size (No Shirts for Preschool)*

Medium 10-12 (YOUTH)
Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Yellow w/ Black Non-Reversible Jersey ($25.00)*

Coed 9th-12th league players use this jersey for games

Yes, I want a Coed 9th-12th league non-reversible jersey
No, I already have this jersey or will find one elsewhere

Yellow w/ Black Non-Reversible Jersey Size*

Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Child Three

Name of Player*

First Last

League of Player*

Coed PreK
Coed Kindergarten
Girls 1st-2nd
Boys 1st-2nd
Girls 3rd-4th
Boys 3rd-4th
Girls 5th-8th**
Boys 5th-8th**
Coed 9th-12th***

**Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
***Coed 9th-12th plays against other community soccer leagues have games on Saturdays and some Sunday afternoons. 7th and 8th graders may choose to "play up" to this league.

Gender*

Date of Birth*

School*

School Grade*

Player’s current school grade or grade they will be enrolled in during the soccer season.

Has played organized soccer before? If Yes how many seasons?*

YES
NO

Number of soccer seasons played*

Fall and Spring are considered separate seasons

Player’s Coach Preference (optional)

We will try our best to accommodate your request depending on availability.

Player’s Practice Preferences

Please list any practice days (M-Th) and times (5p-8p) that player is not available. This information is used to create teams and practice schedules. You may also include player’s preferred practice days and times as well. We will try our best to accommodate your request.

PreK T-shirt*

All PreK league players receive a free t-shirt with registration. One size only (Youth XS); yellow shirt with black “PYSA” text printed on the front. This section is to allow players who may already have a PreK t-shirt (and do not want to receive another one) to opt out of receiving one.

Yes, I want a PreK t-shirt
No, I do not want a PreK t-shirt

Black/Yellow Reversible Jersey ($25.00)*

Yes, I want a new reversible jersey
No, I already have a reversible jersey or will find one elsewhere

All leagues K-8th grade use this jersey for games

Jersey Size (No Shirts for Preschool)*

Medium 10-12 (YOUTH)
Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Yellow w/ Black Non-Reversible Jersey ($25.00)*

Coed 9th-12th league players use this jersey for games

Yes, I want a Coed 9th-12th league non-reversible jersey
No, I already have this jersey or will find one elsewhere

Yellow w/ Black Non-Reversible Jersey Size*

Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Child Four

Name of Player*

First Last

League of Player*

Coed PreK
Coed Kindergarten
Girls 1st-2nd
Boys 1st-2nd
Girls 3rd-4th
Boys 3rd-4th
Girls 5th-8th**
Boys 5th-8th**
Coed 9th-12th***

**Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
***Coed 9th-12th plays against other community soccer leagues have games on Saturdays and some Sunday afternoons. 7th and 8th graders may choose to "play up" to this league.

Gender*

Date of Birth*

School*

School Grade*

Player’s current school grade or grade they will be enrolled in during the soccer season.

Has played organized soccer before? If Yes how many seasons?*

YES
NO

Number of soccer seasons played

Fall and Spring are considered separate seasons

Player’s Coach Preference (optional)

We will try our best to accommodate your request depending on availability.

Player’s Practice Preferences

Please list any practice days (M-Th) and times (5p-8p) that player is not available. This information is used to create teams and practice schedules. You may also include player’s preferred practice days and times as well. We will try our best to accommodate your request.

PreK T-shirt*

All PreK league players receive a free t-shirt with registration. One size only (Youth XS); yellow shirt with black “PYSA” text printed on the front. This section is to allow players who may already have a PreK t-shirt (and do not want to receive another one) to opt out of receiving one.

Yes, I want a PreK t-shirt
No, I do not want a PreK t-shirt

Black/Yellow Reversible Jersey ($25.00)*

Yes, I want a new reversible jersey
No, I already have a reversible jersey or will find one elsewhere

All leagues K-8th grade use this jersey for games

Jersey Size (No Shirts for Preschool)*

Medium 10-12 (YOUTH)
Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Yellow w/ Black Non-Reversible Jersey ($25.00)*

Coed 9th-12th league players use this jersey for games

Yes, I want a Coed 9th-12th league non-reversible jersey
No, I already have this jersey or will find one elsewhere

Yellow w/ Black Non-Reversible Jersey Size*

Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Child Five

Name of Player*

First Last

League of Player*

Coed PreK
Coed Kindergarten
Girls 1st-2nd
Boys 1st-2nd
Girls 3rd-4th
Boys 3rd-4th
Girls 5th-8th**
Boys 5th-8th**
Coed 9th-12th***

**Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
***Coed 9th-12th plays against other community soccer leagues have games on Saturdays and some Sunday afternoons. 7th and 8th graders may choose to "play up" to this league.

Gender*

Date of Birth*

School*

School Grade*

Player’s current school grade or grade they will be enrolled in during the soccer season.

Has played organized soccer before? If Yes how many seasons?*

YES
NO

Number of soccer seasons played

Fall and Spring are considered separate seasons

Player’s Coach Preference (optional)

We will try our best to accommodate your request depending on availability.

Player’s Practice Preferences

Please list any practice days (M-Th) and times (5p-8p) that player is not available. This information is used to create teams and practice schedules. You may also include player’s preferred practice days and times as well. We will try our best to accommodate your request.

PreK T-shirt*

All PreK league players receive a free t-shirt with registration. One size only (Youth XS); yellow shirt with black “PYSA” text printed on the front. This section is to allow players who may already have a PreK t-shirt (and do not want to receive another one) to opt out of receiving one.

Yes, I want a PreK t-shirt
No, I do not want a PreK t-shirt

Black/Yellow Reversible Jersey ($25.00)*

Yes, I want a new reversible jersey
No, I already have a reversible jersey or will find one elsewhere

Jersey Size (No Shirts for Preschool)*

Medium 10-12 (YOUTH)
Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Yellow w/ Black Non-Reversible Jersey ($25.00)*

Coed 9th-12th league players use this jersey for games

Yes, I want a Coed 9th-12th league non-reversible jersey
No, I already have this jersey or will find one elsewhere

Yellow w/ Black Non-Reversible Jersey Size*

Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Child Six

Name of Player*

First Last

League of Player*

Coed PreK
Coed Kindergarten
Girls 1st-2nd
Boys 1st-2nd
Girls 3rd-4th
Boys 3rd-4th
Girls 5th-8th**
Boys 5th-8th**
Coed 9th-12th***

**Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
***Coed 9th-12th plays against other community soccer leagues have games on Saturdays and some Sunday afternoons. 7th and 8th graders may choose to "play up" to this league.

Gender*

Date of Birth*

School*

School Grade*

Player’s current school grade or grade they will be enrolled in during the soccer season.

Has played organized soccer before? If Yes how many seasons?*

YES
NO

Number of soccer seasons played

Fall and Spring are considered separate seasons

Player’s Coach Preference (optional)

We will try our best to accommodate your request depending on availability.

Player’s Practice Preferences

Please list any practice days (M-Th) and times (5p-8p) that player is not available. This information is used to create teams and practice schedules. You may also include player’s preferred practice days and times as well. We will try our best to accommodate your request.

PreK T-shirt*

All PreK league players receive a free t-shirt with registration. One size only (Youth XS); yellow shirt with black “PYSA” text printed on the front. This section is to allow players who may already have a PreK t-shirt (and do not want to receive another one) to opt out of receiving one.

Yes, I want a PreK t-shirt
No, I do not want a PreK t-shirt

Black/Yellow Reversible Jersey ($25.00)*

Yes, I want a new reversible jersey
No, I already have a reversible jersey or will find one elsewhere

All leagues K-8th grade use this jersey for games

Black/Yellow Reversible Jersey Size*

Medium 10-12 (YOUTH)
Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Yellow w/ Black Non-Reversible Jersey ($25.00)*

Coed 9th-12th league players use this jersey for games

Yes, I want a Coed 9th-12th league non-reversible jersey
No, I already have this jersey or will find one elsewhere

Yellow w/ Black Non-Reversible Jersey Size*

Large 14-16 (YOUTH)
Small 34-36 (ADULT)
Medium 38-40 (ADULT)
Large 42-44 (ADULT)
X-Large 44-46 (ADULT)

Parent Information

Name of Parent (Primary Contact)*

First Last

Phone*

Email*

Address*

Add Additional Parent Contact Information

Yes

Parent Name*

First Last

Phone*

Email*

Comments

Please list any physical limitations or medical conditions of the player(s). This information will be given to their Head Coach and League Commissioner.

Are you interested in being a Head Coach this season? If Yes, for what league(s)?*

Head Coach volunteers get one registration at half price.

Yes, I would like to be a Head Coach this season
No

League(s) available to Head Coach*

Coed PreK
Coed Kindergarten
Girls 1st-2nd
Boys 1st-2nd
Girls 3rd-4th
Boys 3rd-4th
Girls 5th-8th
Boys 5th-8th

Name*

Name of parent wanting to be a Head Coach

Email*

Email of parent wanting to be a Head Coach

Are you interested in being an Assistant Coach?*

Yes
No

Name*

Name of the parent wanting to be an assistant coach

Email*

Email of the parent wanting to be an assistant coach

Are you interested in being a League Commissioner?*

This puts you on a list to be contacted for any open Commissioner positions. If you are selected to be a Commissioner, then your registration fee(s) will be refunded to you.

Yes
No

Name*

Name of the parent wanting to be a volunteer League Commissioner

Email*

Email of the parent wanting to be a volunteer League Commissioner

Registration Fee*

Price:

Registration Fee*

Price:

Registration Fee*

Price:

Registration Fee*

Price:

Registration Fee*

Price:

Registration Fee*

Price:

Total

$0.00

RELEASE OF LIABILITY FOR PERSONAL INJURY AND PROPERTY DAMAGE

Our (son(s), daughter(s)) desires to participate in the activities of the Perrysburg Youth Soccer Association, both as a spectator and active participant. We know that it will be necessary for volunteer coaches to teach the skills and rules of soccer; and that the sponsors provide the playing field and possibly other equipment for the players.

Therefore, in consideration of the provision of field and equipment; and the participation in activities of the PYSA; we hereby assume all risk of injury to

Player(s) Name*

First and Last Name(s) of each registered players

First Name	Last Name

and we hereby release discharge and/or otherwise indemnify the PYSA, their affiliated organizations and sponsors, their employees and associated personnel, its players, coaches, aides and owners of fields and facilities utilized for the programs, against any claim and liability for any injury or damage of any kind sustained by such child or by us directly or indirectly in connection with or arising from activities of the PYSA, its members, sponsors, coaches, or otherwise. We acknowledge it is the responsibility of the parent(s) to provide medical supervision if needed for practice or games. We have read this agreement I understand that soccer is potentially a dangerous sport and contains certain inherent risks, whereas participants may receive injuries by falling or colliding with other players, the ball, goal equipment, fencing or other objects.

PARENT OR GUARDIANʼS SIGNATURE*

PRINT PARENT/GUARDIAN NAME*

DATE*

City of Perrysburg Parental Waiver, Consent and Release Form (Ohio Plan Risk Management, Inc.)

The undersigned, in my capacity as parent and/or legal guardian of:

Player(s) Name*

First and Last Name(s) of each registered players

First Name	Last Name

hereby provides consent for my child to participate in Perrysburg Youth Soccer. I understand participation in this event/activity is inherently dangerous and that injury and illness (including communicable diseases such as influenza, MRSA, Coronavirus, etc.) are possible. I agree that I and my child will comply with the stated and customary terms and conditions for participation in regard to protection against injury and infectious disease, both to my child and to others. If I observe any unusual or significant hazard during my child’s participation, I will remove my child from participation and bring such to the immediate attention of an official. If I have reason to believe that my child may have become infectious, I will remove my child from participation until said risk has passed. I agree to waive claims against the City of Perrysburg, its officers, agents, and employees for any and all liability for injury or illness sustained by my child or any other person as a result of my child’s participation Perrysburg Youth Soccer and agree to hold harmless and indemnify the City of Perrysburg, its officers, agents and employees from said liability.

Parent/Guardian Name*

First & Last Name

Parent/Guardian Signature*

SAY SOCCER 2021 Waiver/Release for Injury, Loss & Communicable Diseases including COVID-19

Every player within your organization MUST have a parent or guardian sign off on this statement. If you have any questions, please contact your SAY Administrator prior to completing this agreement.

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of being allowed to participate on behalf of Perrysburg Youth Soccer athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS S.A.Y. Soccer, U.S.A., their officers, officials, coaches, members, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“releasees”), while participating in activities of any kind whether sponsored by or under the supervision of S.A.Y. Soccer U.S.A. and with respect to any and all illness, disability, death, or loss or damage to person or property, whether arising from the negligence of releasees or otherwise, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

Player(s) Name*

First and Last Name(s) of each registered players

First Name	Last Name

Name of Parent/Guardian*

First & Last Name

Parent/Guardian Signature*

Date Signed*

Registration Fee

PERRYSBURG YOUTH SOCCER ASSOCIATION REGISTRATION

RELEASE OF LIABILITY FOR PERSONAL INJURY AND PROPERTY DAMAGE

City of Perrysburg Parental Waiver, Consent and Release Form (Ohio Plan Risk Management, Inc.)

SAY SOCCER 2021 Waiver/Release for Injury, Loss & Communicable Diseases including COVID-19

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