NEWTON GIRLS SOCCER ♦ REGISTRATION FORM
Fall High School 6v6 Program
 Newton Girls Soccer, PO Box 620275, Newton, MA  02462-0275

REGISTRATION FEES:  $65.00 for the first girl, $50.00 for the second, and $40.00 for each additional girl from the same family.  In determining the total family fee, consider all girls playing NGS (BAYS travel and intramural).  In case of family hardship, the fee(s) will be reduced or waived (see above).  Strict confidence will be observed.  No refunds can be made after August 31, 2001 unless a player makes her varsity high school team and thereby is ineligible for the fall NGS program.

Name: Grade ('01-'02):
Street: Zip:
Phone: DOB: School:*
Parent's email address: Fee:

* If a private school student, list that school and the Newton school she would have attended (e.g., BBN/Brown or Schecter/Bowen)

  PLEASE HELP!!:I am willing to help as a coach an assistant coach   Name

CHARITABLE DONATION: In order to continue to offer quality soccer, additional funds are needed to cover rising expenses for new equipment and to help create and maintain safe fields.  Please consider adding a tax-deductible contribution to your player registration fee.

CONTRIBUTION:  $10 $25 Other $

COMPLETE AND SIGN THIS RELEASE/CONSENT FOR EMERGENCY MEDICAL/DENTAL TREATMENT

RELEASE: I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the USYSA, MYSA, BAYS and NGS, their affiliated organizations and sponsors.  I desire to have the registrant participate in the soccer programs and activities, including indoor/outdoor play, practices, clinics and matches ("Programs") offered by USYSA, MYSA, BAYS, NGS, and/or their affiliated organizations and sponsors.  Recognizing the possibility of physical injury associated with soccer and the registrant's participation in the Programs, and in consideration for the USYSA, MYSA, BAYS and NGS accepting the registrant for participation in the Programs, on behalf of myself and the registrant, I hereby release, discharge and/or otherwise indemnify the USYSA, MYSA, BAYS, NGS and their affiliated organizations and sponsors, their respective officers, directors, coaches, committees, employees and associated personnel, including the owner of fields and facilities utilized for the Programs, of and from any claim, demand, action, cause of action, suit or liability arising as a result of the registrant's participation in the Programs, including the transport of the registrant to or from the Programs, which transportation I hereby authorize.

EMERGENCY MEDICAL CARE:  As parent or legal guardian of the minor named on this form, I hereby give my consent to seek, obtain and provide emergency medical/dental treatment in case of injury that occurs while participating in NGS-related activities.  This care may be given under whatever conditions are necessary to preserve life, limb or well-being of such minor.  I understand that such treatment will be sought and provided only in an emergency and that reasonable efforts will be made to contact me before providing such treatment.

 Parent/Guardian Name (Print):   Date:
 Parent/Guardian Signature:  

TO PARENT/GUARDIAN: You are not required to provide the following information. However, this information will be useful if the minor requires emergency medical/dental treatment.

Date of last tetanus shot Other allergies:
Allergies to medications:   Present medications: