Child's Full Name

Child's Date of Birth

Child's Grade

Child's Gender Male Female

NOTE: The FGSA will be using the same game t-shirts for the Spring 2010 season as were used in during the Fall 2009 season. If you need to order another shirt, it will cost an additional $5 on top of the $25 league registration fee.

Does your child need a t-shirt? No Yes

***If a t-shirt is needed, please indicate the size below***

Year's of Soccer Experience 0-1 1-2 2-3 3+

Parent(s) Name(s)

Phone Number

E-mail Address

Street Address

City

State

Zip Code

Emergency Contact

Emergency Contact's Phone Number

Any medical conditions or other information the FGSA staff should know about?

The FGSA runs with the help of parent volunteers who help to organize their son or daughter's team on game days and acts as a point of contact between their team parents and the FGSA coaching staff. Please indicate below if you would like to volunteer and indicate the best way to contact you. No soccer experience is necessary. Training and all necessary information will be provided by the FGSA coaching staff.

Waiver of Liability

By checking the above box I acknowledge my understanding that the game of soccer is a physical and contact sport. While the FGSA will do everything in its power to provide a safe environment for all players, I understand that the FGSA or any member of its staff cannot be held responsible for any incident that may result in injury to a player through the course of play.