2017 HONEOYE LAKE UNITED SOCCER CLUB

SUMMER SOCCER REGISTRATION FORM

U9 (U11c), U11, U13 (Modified Level), U15 (JV Level) & U18 (Varsity Level)
Based on Player's Age Before December 31st, 2017. Cannot have graduated HS.

Player's Name:_________________________________________ Date of Birth:________________

Mailing Address:________________________________________ Zip Code___________________
Email Address:_____________________________________________________________________
Parent Cell #:__________________________ Player Cell #:________________________________
Parent/Guardian Names:_____________________________________________________________
Doctor's Name:_______________________________________Doctor's Phone:________________
Medical Concerns:__________________________________________________________________

Deadline is March 31th 2017

Cost is $80
Mail registration form, $80 fee, **and an approx. 1 inch by 1 inch photo
of player's FACE for I.D. badge to**:
HLUSC
4869 Fawn Ridge
Canandaigua, NY 14424

Visit our Facebook page Honeoye Lake United Soccer Club or contact Ken
Jarosinski kjarosinski@frontiernet.net or 585-313-7189 for information or questions.

Jersey & Short Size (If different, please specify):

Youth Small Youth Medium Youth Large
Adult Small Adult Medium Adult Large Adult X-Large

Teams will play approx. twice a week from mid June through the end of July for 10 games total (5 Home/5
Away). Home game are at Honeoye Central School. Away games are against WAYNE COUNTY TEAMS which
MAY or MAY NOT include; Marion, Waterloo, Palmyra, North Rose, Williamson, Newark, Red Jacket etc...
I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the WFYSLA, NYWYSA its affiliated organizations and sponsors.
Recognizing the possibility of physical injury associated with soccer and in consideration for the WFYSLA, accepting the registrant for its soccer programs and activities (the
Programs), I hereby release, discharge and/or otherwise indemnify the WFYSLA, its affiliate 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 as a result of the registrant's participation in the Programs and/or
being transported to or from the same, which transportation I hereby authorize. As the parent/guardian of the above named player, I hereby consent, if I am not present and
cannot be reached with reasonable efforts, to emergency medical care prescribed by a duly licensed doctor of medicine or doctor of dentistry, under whate3ver conditions are
necessary to preserve the life, limb or well being of the player.

Please sign below to acknowledge and agree to Consent to Participation,

Liability Waiver and Release and Consent for Medical Treatment.
Date: __________ Signature of Parent or Guardian:________________________________________