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Include this form with check or money order made payable to HYSA

FALL 2014. Include this form with check or money order made payable to HYSA ALL registrations need to include a birth certificate. MAIL TO: HYSA, P.O. BOX 992, BUDA, TX 78610 OR Register online at www.haysyouthsoccer.org. PLEASE PRINT PLAYER INFORMATION Last Name First Middle

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Include this form with check or money order made payable to HYSA

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  1. FALL 2014 Include this form with check or money order made payable to HYSA ALL registrations need to include a birth certificate. MAIL TO: HYSA, P.O. BOX 992, BUDA, TX 78610 OR Register online at www.haysyouthsoccer.org PLEASE PRINT PLAYER INFORMATION Last Name FirstMiddle AddressCity Zip Home Phone Player date of birth Gender M F Player’s Age Group – Circle Bracket Division 4 U5 Coed (8/1/09 to 7/31/10) Fee $75 U6 Coed (8/1/08 to 7/31/09) Fee $95 U8 Boys/U8 Girls (8/1/06 to 7/31/08) Fee $110 U10 Coed (8/1/04 to 7/31/06) Fee $115 Player’s Age Group – Circle Bracket Division 3 U12 Boys/U12 Girls (8/1/02 to 7/31/04) Fee $130 U14 Boys/U14 Girls (8/1/00 to 7/31/02) Fee $130 U15 Boys/U15 Girls (8/1/99 to 7/31/00) Fee $130 U16 Boys/U16 Girls (8/1/98 to 7/31/99) Fee $130 U18 Boys/U18 Girls (8/1/96 to 7/31/97) Fee $130 Mother’s NameCell # Email Father’s Name Cell # Email Please list email addresses as email will be one of the primary means of communication. SIGNATURE of PARENT or LEGAL GUARDIAN:DATE: Parent/Legal Guardian signature REQUIRED to complete registration. LIST ANY SPECIAL REQUEST, PLAYER MEDICAL PROHIBITIONS/LIMITATIONS BELOW: Examples: Request to play in older age bracket; placement w/particular team/coach; asthma; etc. PARENTAL SUPPORT – For HYSA to work, we need active participation from ALL families in the Program. Each family is required to commit to 4 hours of volunteer work and a mandatory fundraiser per season or choose to opt out and pay the opt out fee(s), due at time of registration. Please note, only one opt out fee is required per family (not per child). **CIRCLE OPTION** Volunteer OR Opt Out $25 Fundraising OR Opt Out $25 TEAM SUPPORT – Please circle any areas which you would be interested in assisting: REFEREE *HEAD COACH *ASSISTANT COACH BOARD MEMBER *counts towards volunteer hours ALL COACHES MUST BE REGISTERED WITH KidSafe AND HAVE THEIR COACH LICENSE(S) ON FILE Registrations postmarked after deadline will be assessed **Registrations received after the deadline will be subject to team availability on a first come ,first served basis.** OFFICIAL HYSA USE ONLY Registration Received DateVolunteer Opt OutTotal Due Fee DueLate FeesPayment Received

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