PERRYSBURG YOUTH SOCCER ASSOCIATION REGISTRATION 2023 Fall Season Registration opens: July 1 - August 6 Late registration: August 7 - August 20 Waitlist: August 21 - September 10 Games: September 16 - October 21
Number of Players to Register* 1 2 3 4 5 6
Child One
Name of Player*
First
Last
League of Player* *Coed PreK (ages 3-4 or enrolled in PreK)
*Kindergarten (ages 5-6 and enrolled in Kindergarten)
**Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
Gender* SELECT MALE FEMALE
Date of Birth*
MM slash DD slash YYYY
School*
School Grade* School grade the player will be enrolled in during the soccer season.
Has player participated in an organized soccer league before?* Number of soccer seasons played Fall and Spring are considered separate seasons
Player’s Practice Availability Player’s Practice Availability* Please select all day(s) player is available for practice. Coed Kindergarten - 8th Leagues have practice for one hour (between 5p-8p timeframe) on the following weekdays during the season.
Player’s Practice Availability* Please select all day(s) player is available for practice. Coed 9th-12th League typically holds practices for one hour (between 5p-8p
timeframe) one or two days a week during the season.
Player’s Teammate Preferences (optional) Please list first and last name for up to two teammate requests for this player. We will try our best to accommodate request(s) depending on
availability.
Player’s Coach Preferences (optional) Please list first and last name for up to two Coach requests for this player. We will try our best to accommodate request(s) depending on
availability.
Additional Player Practice/Team Preference Comments We will try our best to accommodate any preferences or requests.
Additional Player Practice/Team Preference Comments Coed 9th-12th League has one team and one preselected coach. No need to make any specific teammate or coach requests. We will try our best to accommodate any other preferences or requests.
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.
Black/Yellow Reversible Jersey ($25.00)* All leagues K-8th grade use this jersey for games
Black/Yellow Reversible Jersey Size* Yellow w/ Black Non-Reversible Jersey ($25.00)* Coed 9th-12th league players use this jersey for games
Yellow w/ Black Non-Reversible Jersey Size* Child Two
Name of Player*
First
Last
League of Player* **Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
Gender* SELECT MALE FEMALE OTHER
Date of Birth*
MM slash DD slash YYYY
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?* Number of soccer seasons played Fall and Spring are considered separate seasons
Player’s Practice Availability Player’s Practice Availability* Please select all day(s) player is available for practice. Coed Kindergarten - 8th Leagues have practice for one hour (between 5p-8p timeframe) on the following weekdays during the season.
Player’s Practice Availability* Please select all day(s) player is available for practice. Coed 9th-12th League typically holds practices for one hour (between 5p-8p
timeframe) one or two days a week during the season.
Player’s Teammate Preferences (optional) Please list first and last name for up to two teammate requests for this player. We will try our best to accommodate request(s) depending on
availability.
Player’s Coach Preferences (optional) Please list first and last name for up to two Coach requests for this player. We will try our best to accommodate request(s) depending on
availability.
Additional Player Practice/Team Preference Comments We will try our best to accommodate any preferences or requests.
Additional Player Practice/Team Preference Comments Coed 9th-12th League has one team and one preselected coach. No need to make any specific teammate or coach requests. We will try our best to accommodate any other preferences or requests.
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.
Black/Yellow Reversible Jersey ($25.00)* All leagues K-8th grade use this jersey for games
Jersey Size (No Shirts for Preschool)* Yellow w/ Black Non-Reversible Jersey ($25.00)* Coed 9th-12th league players use this jersey for games
Yellow w/ Black Non-Reversible Jersey Size* Child Three
Name of Player*
First
Last
League of Player* **Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
Gender* SELECT MALE FEMALE OTHER
Date of Birth*
MM slash DD slash YYYY
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?* Number of soccer seasons played* Fall and Spring are considered separate seasons
Player’s Practice Availability Player’s Practice Availability* Please select all day(s) player is available for practice. Coed Kindergarten - 8th Leagues have practice for one hour (between 5p-8p timeframe) on the following weekdays during the season.
Player’s Practice Availability* Please select all day(s) player is available for practice. Coed 9th-12th League typically holds practices for one hour (between 5p-8p
timeframe) one or two days a week during the season.
Player’s Teammate Preferences (optional) Please list first and last name for up to two teammate requests for this player. We will try our best to accommodate request(s) depending on
availability.
Player’s Coach Preferences (optional) Please list first and last name for up to two Coach requests for this player. We will try our best to accommodate request(s) depending on
availability.
Additional Player Practice/Team Preference Comments We will try our best to accommodate any preferences or requests.
Additional Player Practice/Team Preference Comments Coed 9th-12th League has one team and one preselected coach. No need to make any specific teammate or coach requests. We will try our best to accommodate any other preferences or requests.
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.
Black/Yellow Reversible Jersey ($25.00)* All leagues K-8th grade use this jersey for games
Jersey Size (No Shirts for Preschool)* Yellow w/ Black Non-Reversible Jersey ($25.00)* Coed 9th-12th league players use this jersey for games
Yellow w/ Black Non-Reversible Jersey Size* Child Four
Name of Player*
First
Last
League of Player* **Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
Gender* SELECT MALE FEMALE OTHER
Date of Birth*
MM slash DD slash YYYY
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?* Number of soccer seasons played Fall and Spring are considered separate seasons
Player’s Practice Availability Player’s Practice Availability* Please select all day(s) player is available for practice. Coed Kindergarten - 8th Leagues have practice for one hour (between 5p-8p timeframe) on the following weekdays during the season.
Player’s Practice Availability* Please select all day(s) player is available for practice. Coed 9th-12th League typically holds practices for one hour (between 5p-8p
timeframe) one or two days a week during the season.
Player’s Teammate Preferences (optional) Please list first and last name for up to two teammate requests for this player. We will try our best to accommodate request(s) depending on
availability.
Player’s Coach Preferences (optional) Please list first and last name for up to two Coach requests for this player. We will try our best to accommodate request(s) depending on
availability.
Additional Player Practice/Team Preference Comments We will try our best to accommodate any preferences or requests.
Additional Player Practice/Team Preference Comments Coed 9th-12th League has one team and one preselected coach. No need to make any specific teammate or coach requests. We will try our best to accommodate any other preferences or requests.
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.
Black/Yellow Reversible Jersey ($25.00)* All leagues K-8th grade use this jersey for games
Jersey Size (No Shirts for Preschool)* Yellow w/ Black Non-Reversible Jersey ($25.00)* Coed 9th-12th league players use this jersey for games
Yellow w/ Black Non-Reversible Jersey Size* Child Five
Name of Player*
First
Last
League of Player* **Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
Gender* SELECT MALE FEMALE OTHER
Date of Birth*
MM slash DD slash YYYY
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?* Number of soccer seasons played Fall and Spring are considered separate seasons
Player’s Practice Availability Player’s Practice Availability* Please select all day(s) player is available for practice. Coed Kindergarten - 8th Leagues have practice for one hour (between 5p-8p timeframe) on the following weekdays during the season.
Player’s Practice Availability* Please select all day(s) player is available for practice. Coed 9th-12th League typically holds practices for one hour (between 5p-8p
timeframe) one or two days a week during the season.
Player’s Teammate Preferences (optional) Please list first and last name for up to two teammate requests for this player. We will try our best to accommodate request(s) depending on
availability.
Player’s Coach Preferences (optional) Please list first and last name for up to two Coach requests for this player. We will try our best to accommodate request(s) depending on
availability.
Additional Player Practice/Team Preference Comments We will try our best to accommodate any preferences or requests.
Additional Player Practice/Team Preference Comments Coed 9th-12th League has one team and one preselected coach. No need to make any specific teammate or coach requests. We will try our best to accommodate any other preferences or requests.
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.
Black/Yellow Reversible Jersey ($25.00)* Jersey Size (No Shirts for Preschool)* Yellow w/ Black Non-Reversible Jersey ($25.00)* Coed 9th-12th league players use this jersey for games
Yellow w/ Black Non-Reversible Jersey Size* Child Six
Name of Player*
First
Last
League of Player* **Grades 5th-8th are coed if there are not enough players to split into boys and girls leagues.
Gender* SELECT MALE FEMALE OTHER
Date of Birth*
MM slash DD slash YYYY
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?* Number of soccer seasons played Fall and Spring are considered separate seasons
Player’s Practice Availability Player’s Practice Availability* Please select all day(s) player is available for practice. Coed Kindergarten - 8th Leagues have practice for one hour (between 5p-8p timeframe) on the following weekdays during the season.
Player’s Practice Availability* Please select all day(s) player is available for practice. Coed 9th-12th League typically holds practices for one hour (between 5p-8p
timeframe) one or two days a week during the season.
Player’s Teammate Preferences (optional) Please list first and last name for up to two teammate requests for this player. We will try our best to accommodate request(s) depending on
availability.
Player’s Coach Preferences (optional) Please list first and last name for up to two Coach requests for this player. We will try our best to accommodate request(s) depending on
availability.
Additional Player Practice/Team Preference Comments We will try our best to accommodate any preferences or requests.
Additional Player Practice/Team Preference Comments Coed 9th-12th League has one team and one preselected coach. No need to make any specific teammate or coach requests. We will try our best to accommodate any other preferences or requests.
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.
Black/Yellow Reversible Jersey ($25.00)* All leagues K-8th grade use this jersey for games
Black/Yellow Reversible Jersey Size* Yellow w/ Black Non-Reversible Jersey ($25.00)* Coed 9th-12th league players use this jersey for games
Yellow w/ Black Non-Reversible Jersey Size* Guardian Information
Name of Guardian (Primary Contact)*
First
Last
Relationship to player*
Phone*
Email* Address*
Add Second Guardian Contact Information Name of Guardian (Secondary Contact)*
First
Last
Relationship to player*
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?* Head Coach volunteers get half-off one registration per team they coach. Head Coaches will be reimbursed when selected to coach for the upcoming season.
League(s) available to Head Coach* 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?* League(s) available to Assistant Coach* 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?* If yes, you will be added to a contact list if/when any League Commissioner positions open. If you are selected to be a Commissioner, then your registration fee(s) will be refunded to you.
Name* Name of the parent wanting to be a volunteer League Commissioner
Email* Email of the parent wanting to be a volunteer League Commissioner
Are you a League Commissioner this season? League(s)
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.
Player(s) Name* First and Last Name(s) of each registered players
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*
MM slash DD slash YYYY
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
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. Player(s) Name* First and Last Name(s) of each registered players
Name of Parent/Guardian*
First & Last Name
Parent/Guardian Signature* Date Signed*
MM slash DD slash YYYY
SUDDEN CARDIAC ARREST AND LINDSAY’S LAW What is Lindsay’s Law? Which youth athletic activities are included in Lindsay’s law?
Athletics at all schools in Ohio (public and non-public)
Any athletic contest or competition sponsored by or associated with a school
All interscholastic athletics, including all practices, interschool practices and scrimmages
All youth sports organizations
All cheerleading and club sports, including noncompetitive cheerleading
What is SCA? What is a warning sign for SCA? What symptoms are a warning sign of SCA? A young athlete may have these things with exercise:
Chest pain/discomfort
Unexplained fainting/near fainting or dizziness
Unexplained tiredness, shortness of breath or difficulty breathing
Unusually fast or racing heart beats
What happens if an athlete experiences syncope or fainting before, during or after a practice, scrimmage, or competitive play? What happens if an athlete experiences any other warning signs of SCA? Who can evaluate and clear youth athletes? What is needed for the youth athlete to return to the activity? All youth athletes and their parents/guardians must review information about Sudden Cardiac Arrest, then sign and return this form. Child One
Parent/Guardian Signature* Student Signature* Parent/Guardian Name*
Student Name*
Date Signed*
MM slash DD slash YYYY
Date Signed*
MM slash DD slash YYYY
Child Two
Parent/Guardian Signature* Student Signature* Parent/Guardian Name*
Student Name*
Date Signed*
MM slash DD slash YYYY
Date Signed*
MM slash DD slash YYYY
Child Three
Parent/Guardian Signature* Student Signature* Parent/Guardian Name*
Student Name*
Date Signed*
MM slash DD slash YYYY
Date Signed*
MM slash DD slash YYYY
Child Four
Parent/Guardian Signature* Student Signature* Parent/Guardian Name*
Student Name*
Date Signed*
MM slash DD slash YYYY
Date Signed*
MM slash DD slash YYYY
Child Five
Parent/Guardian Signature* Student Signature* Parent/Guardian Name*
Student Name*
Date Signed*
MM slash DD slash YYYY
Date Signed*
MM slash DD slash YYYY
Child Six
Parent/Guardian Signature* Student Signature* Parent/Guardian Name*
Student Name*
Date Signed*
MM slash DD slash YYYY
Date Signed*
MM slash DD slash YYYY
