Litchfield Youth Soccer League Travel
R E G I S T R A T I O N
NHSL Membership Form

New Hampshire Soccer Association
* Required
PARENT / GUARDIAN INFORMATION:
* Mother's First Name:

* Mother's Last Name:

* Mother's Cell Phone:

* Mother's E-mail:
* Father's First Name:

* Father's Last Name:

* Father's Cell Phone:

* Father's E-mail:
* Home Phone:
* Street:
* City/Town: * State: * Zip:
* Emergency Contact: * Phone:
* Physician Contact: * Phone:
PLAYER 1 INFORMATION:
* First Name: * Last Name: MI:
* Gender: Female Male     * Date Of Birth:     * Current School Grade:
Registration Age (based on age as of July 31, 2014):
Player's division based on registration age:
Comments (for example, soccer experience and any medical problem or prohibition player has):
WE NEED YOUR HELP!! No experience necessary - just a willingness to help.
Without parent/coach volunteers, LYSL may be unable to have as many teams as needed. Yes!!! I can volunteer:
Coach Asst. Coach Team Parent Field Improvements
NHSL RELEASE:
I, the parent/guardian of the player(s), minor(s), agree that the registrant(s) and I will abide by the rules of NHSL, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the NHSL accepting the registrant(s) for its soccer program and activities (the "Programs"), I hereby release, discharge and/or otherwise indemnify the NHSL, 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(s) as a result of a registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize:
I agree *
LYSL RELEASE:
I, the parent/guardian of the player(s), minor(s), agree that the registrant(s) and I will abide by the rules and regulations of the LYSL as stated in the LYSL Code of Conduct. I am also acknowledging that I will be responsible for passing the tenants of this code of conduct along to any guests that I may bring to an LYSL activity. Recognizing the possibility of physical injury associated with soccer participation and in consideration for the LYSL accepting the registrant(s) for its soccer program and activities ("the program"), I hereby release, discharge and/or otherwise indemnify the LYSL including its officers, referees, coaches, assistants, and other volunteer personnel as well as the owners of the fields, facilities used by the program, against any claim by or on behalf of the registrant(s) as result of the registrant(s)'s participation in the program and/or being transported to or from the same, which transportation I hereby authorize:
I agree *
CONSENT FOR MEDICAL TREATMENT (MINOR):
As parent of Legal Guardian of the above named player(s), I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatsoever conditions as may be necessary to preserve life, limb, or well being of my player(s).
I agree *
REGISTER: