Players Name:

Street:

City:

State:

Zip:

Did the player play with GCUFC last year?

Who did they play with?

Do you need a uniform?

If a uniform is needed select sizes below:

Jersey:

Shorts:

Wind Suit:

Date Of Birth

Gender:

Age Group:

Parent or Guardian:

Primary Email Address:

Mother:

Work Phone:

Home Phone:

Cell Phone:

Secondary Email:

Father:

Work Phone:

Home Phone:

Cell Phone:

Secondary Email:

MEDICAL

(PLEASE LIST ANY MEDICAL PROBLEMS OR REQUIRED MEDICATION)

In Case of Emergency Notify:

Phone #:

The parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the results of the USYSA, its affiliated organizations and sponsors.  Recognizing the possibility of physical injury associated with soccer and in consideration of the USYSA accepting the registrant for its soccer programs and activities, I hereby release, discharge and/or indemnify the USYSA, its affiliated organizations and sponsors, their employees and associate personnel including the owners of fields and facilities utilized of the programs, against any claim by or on the 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.  I furthermore want to be registered by the GCUFC and pay fees now in full and state that GCUFC or anyone on my behalf may pay USYSA fees and associate fees to make certain the registration is valid.

Type Name Here As Digital Signature:

Date: