Dear Parents:
It is now time to register your son or daughter for the Fall 2015 Putnam County West soccer season at Continental. Age groups are as follows: 6 and 7, 8 and 9, 10 and 11, 12 and 13. Any child who is five by July 31 is eligible to play and any 14 year-old eighth grader will be eligible to play with the 12 & 13 year-olds.
The attached form needs to be completed in full with parent/guardian signature. The fee will be $35 per player. The fee provides your child with a new, good quality uniform (which includes a jersey, shorts and socks) and helps cover the cost of team registration, equipment, liability insurance and officials. The registration fee and completed forms can be mailed to the Continental Soccer Club, at the address below, anytime before Saturday, May 17, 2015. Please do not send the form to school with your child. A late fee of $10.00 per child will be assessed if the registration is received after May 17. Team draws will be held the last week of May.
Anyone willing to volunteer as a coach, assistant coach or referee, please indicate so on the registration form or contact Annette Hoeffel at 419-596-5377 prior to the May 17 deadline. Please remember your assistance and involvement is needed for the continued success of the Continental Youth Soccer Program.
The regular soccer season will begin on August 13.
We are excited about the upcoming soccer season and look forward to seeing you this fall on the soccer field. Thank you for supporting the Putnam West Soccer program in Continental.
Sincerely,
Putnam County West Soccer
Annette Hoeffel & Josh Crossgrove
Make checks payable to and mail to:
Continental Soccer Club
P.O. Box 285
Continental, Ohio 45831
Click here for registration form.
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PUTNAM COUNTY YOUTH SOCCER LEAGUE – WEST
REGISTRATION FORM
Due Saturday, May 17, 2015
Player Fee $35.00
Player’s Name_____________________________________________ Sex M______ F______
Parent’s Name________________________________________ Phone__________________
Address_____________________________________________________________________
E-mail address___________________________________ Cell Phone____________________
Age (on 7/31/2015)__________ Birthdate______/______/______ New Player: Yes No
Sibling in Same Age Group_________________________________
SHIRT SIZE (circle one) Youth: YS YM YL Adult: AS AM AL AXL
SHORT SIZE (circle one) Youth: YS YM YL Adult: AS AM AL AXL
**We suggest you order the shirt one size larger so another shirt can be worn underneath when the weather is cold.
We welcome any and all who could volunteer their time and skills to enhance our program. If you think you can assist us in any way, please indicate below and we will contact you.
COACH_______ ASST. COACH_______ REFEREE______ SERVE ON BOARD_______
We hereby agree that the Putnam County West Soccer its members, coaches or officers shall not be liable for any injury or loss which my child may sustain while participating in activities of any kind whether sponsored by or under the supervision of Putnam County West Soccer and we agree to indemnify and to hold harmless Putnam County West Soccer, its members, coaches, officers or designates of any kind from any claim whatsoever.
Parent or Guardian Signature_______________________________________ Date_________
We need your help in maintaining an acceptable level or behavior by everyone who attends a PCYSL-West soccer game. We must focus on the love of the game and eliminate the negative side of competitiveness that may cause ugly incidents. By signing up your child for Putnam County Youth Soccer League – West, you agree to abide by this Code of Ethics: It shall be against the rules of PCYSL-West for a spectator, parent, coach or player to threaten, harass or intimidate soccer officials, players and/or coaches in any way. This includes before, during and after all games sanctioned by the PCYSL-West. Failure to comply with these stated rules could mean immediate expulsion from the game and/or field area by judgment of the Franchise Review Board of this Soccer Association. Please help the league achieve our goal of creating a positive environment where our young soccer players can learn and flourish.
DO NOT WRITE BELOW – SOCCER ORGANIZATION USE ONLY
Playing Age (as of July 31) _________________ Coach/Team_______________________________
Fee Paid $_____________ Cash Check #_________ Date______________________________
** Continental Soccer Club ** P.O. Box 285 ** Continental, Ohio 45831 **
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EMERGENCY MEDICAL AUTHORIZATION
Purpose: To enable parents and guardians to authorize the provision of emergency treatment for children who become ill or injured when parents or guardians cannot be reached. Please complete Part 1 OR 2 not both.
PART 1
TO GRANT:
In the event reasonable attempts to contact me at ___________ (phone#) or _______________(name of other parent/guardian) at ______________(phone #) have been unsuccessful. I hereby give my consent for: 1. the administration of any treatment deemed necessary by Dr. ____________________ (preferred physician) or Dr.____________________ (preferred dentist) or, in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and 2. the transfer of the child to ____________________(preferred hospital) or any hospital within reasonable access.
This authorization does not cover major surgery, unless the medical opinions of two licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.
Facts concerning the child’s medical history including allergies, medications being taken and any physical impairments to which a physician should be alerted:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________ Date_____________________
Signature of Parent or Guardian
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –
PART 2
TO REFUSE:
I do not consent for emergency medical treatment for my child and agree that by execution of this refusal to consent; myself or my spouse will be present at all practices or games and will transport my child to or from practices or games. In the event that I am not present, then I understand my child will not participate.
____________________________________________ Date_____________________
Signature of Parent or Guardian
