TUPELO PARKS and RECREATION
TYSA/TFC SOCCER REGISTRATION 2001 - 2002 SEASON
1st Players Name: _________________________________________ Did you play TDPR Soccer last year? ________
Address: _______________________________________ City: __________________ State: _____ ZIP: _________
Birthday: (mmddyy): ________________ Age (as of 7/31/01): ________ Gender (male or female): ____________
Home Phone: ____________________________ Family E-mail Address: _______________________________
2nd Players Name: ____________________________________ Did you play TDPR Soccer last year? _________
Birthday: (mmddyy): ________________ Age (as of 7/31/01): ________ Gender (male or female): ____________
REGISTRATION FEES (circle the amount(s) you will owe)
| League/Age Group as of 7/31/00 |
Live in the City of Tupelo |
Live in the Tupelo School District |
Live out of School
District Attend Tupelo School |
Live in Lee County Attend Lee Co. School |
| Recreational (Under 6) | $30.00 | $40.00 | $55.00 | $55.00 |
| Recreational (Under 19) | $35.00 | $45.00 | $60.00 | $60.00 |
| Select (all ages) | $40.00 | $50.00 | $65.00 | $65.00 |
Parent Name: _________________________ Bus. Phone: __________________ Home Phone: ________________
Parent Name: _________________________ Bus. Phone: __________________ Home Phone: ________________
We ask for active participation by Parents in our program. Please check one of the following if you are interested.
________ Coach ________Assistant Coach ________Referee ________ Committee Member
Please note that you are registering to play soccer but not with a particular team
| I am the parent or guardian of the child listed above. I understand and acknowledge that my child's participation in this sports program, including all related activities, exposes my child to the risk of injury, both minor and potentially serious, and that such injuries are not uncommon, including transportation to and from sports activities. I agree to abide by the policies, guidelines and safety requirements of the Department of Parks and Recreation and the objectives and goals of the Youth Athletic Program, and I will instruct my child to do the same and to follow all safety rules and regulations. As an inducement to the City of Tupelo and the Parks and Recreation Department to allow my child to participate in this sports program, I agree to defend and hold harmless the City of Tupelo, the Department of Parks and Recreation, the Tupelo Advisory Board, the sponsors, staff and volunteer supervisors for any and all claims made on behalf of my child for injuries or damage arising from participation in the sports program or related activities. |
Date: _____________ Signature of Parent/ Guardian: ______________________________________
Payment: $___________ Check #:___________ Verified by P&R Rep:__________