Tryout # _______

Club Registration / Release Form Revised: 2017

PPlayers who are selected and commit to play for the Freedom Soccer Club are members of their team for a period of one year, beginning July 1, 2017 and ending June 30, 2018.

Please check the appropriate box:

U8 Born 2010 U9 Born 2009 U10 Born 2008 U11 Born 2007 U12 Born 2006 U13 Born 2005 U14 Born 2004 U15 Born 2003U U16 Born 2002 U17/18/19

Born 1999/2000/2001

PLEASE TYPE OR PRINT ALL INFORMATION LEGIBLY -PLAYER’S INFORMATION Player’s Name:

Player’s Address:

City, State & ZIP

Date of Birth Check One

M F

Fall 2017 School ------------------------Fall Grade Level

Team Played for Last Season

Other Sports /Activities

Medical Conditions

PARENT/GUARDIAN INFORMATION Father’s Name

Phone #: (_____) ________ - __________(c) (_____) ________ - _________(h)

Email Address:

Mother’s Name

Phone #: (_____) ________ - __________(c) (_____) ________ - _________(h)

Email Address:

If my child is selected, please call this number on the SUNDAY after tryouts: (please print legibly) ______________________________________________________________________________________

Release/ Waiver: Code of Conduct: Disclosure: Deposit: Signature:

Release: I recognize the possibility of injury associated with soccer, this tryout, and my involvement with the Freedom Soccer Club (FSC), its teams, and all related activities. I hereby release, discharge, and otherwise indemnify the FSC, its affiliated organizations, the club directors, coaches, sponsors, volunteers, and associated personnel including the facility owners and their employees, from any claim by or on behalf of the registrant as a result of the registrant’s participation and/or being transported to and from events with the FSC. This includes but is not limited to injuries, illness, losses or damages of any kind to person or personal property incurred during my involvement. I authorize the Freedom Soccer Club, its directors, coaches, and associated personnel to act on my child’s behalf according to their best judgment in any incident or emergency requiring medical or other attention.

Code of Conduct: The FSC expects players, parent/guardians, and family members to demonstrate good sporting behavior before, during, and after club/team activities. Any player or players’ family member displaying unsporting behavior involving teammates, officials, opponents or coaches may result in my child being removed from the team/club.

Disclosure: I understand that 1)information collected on this form will be used by officials of affiliated soccer organizations to establish my child’s eligibility to participate in the Freedom Soccer Club (FSC) 2) the information will not be disclosed except to officials of the affiliated soccer organizations and the associated Parks’ Board, 3) the names, address(es), and phone number(s) on this form may be shared with members of the team that my child plays on; and 4) personal information will be held one year in case my child re-registers for FSC. I consent to the disclosure and use of this information to the extent noted here

Note: A $400 nonrefundable deposit is due at the first team meeting. The fee schedule/due dates will be given at that meeting. Players must be in good standing with the club before participating. Fees are nonrefundable.

As the parent/guardian of the player named, by signing below I am indicating that I understand and acknowledge all items above and provide my consent for emergency medical treatment, and waive liability during the tryout and any associated time with FSC. X ____________________________________________Date: ____________________

ID # [ ]

US YOUTH MEMBERSHIP FORM

United States Youth Soccer Association Member of the United States

Soccer Federation (USSF) Affiliated with the Federation

Internationale de FootballAssociation (FIFA)

OHIO SOUTH YOUTH SOCCER ASSOCIATION, INC. - PLAYERS

Male = M Coach's FOR LEAGUE USE ONLYFemale = F License Level TRANSFER NEW RE-REGISTRATION CHANGE/CORRECTION

[ ] [ ] [ ] [ ] [ ] [ ]

This section must be completed by the team coach League AgeName Group_______

Club/TeamName

(USE CODE ONLY)>

2B

OHS

Region State District League Club Team Recreational = R Competitive = C

LastName

FirstName

Init.

Address. City

State Zip Code Area Code Telephone Number

BirthDate

Mo. Day Year

SPECIAL NOTE TO ALL PLAYERS THAT PLAYED HIGH SCHOOL SOCCER LAST FALLOHIO HIGH SCHOOL ATHLETIC ASSOCIATION RULES LIMIT OSYSA TEAMS TO NO MORE THAN FIVE (5)

WHO PLAYED HIGH SCHOOL SOCCER AT THE SAME HIGH SCHOOL LAST FALL

(VARSITY, JV, FRESHMAN) FROM BEING ON THE SAME OSYSA TEAM PRIOR TO JUNE 1.

Father's Name Occupation Bus. Phone: _______________

Mothers's Name Occupation Bus. Phone

List any medical problems or prohibition player has ________________________________________________________________

Person to notify in emergency Telephone ___

Doctor to notify in emergency Telephone ______

CONSENT FOR MEDICAL TREATMENT (MINOR)

As the parent or legal guardian of the above-named player, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Denistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent.Signature of the Parent/Guardian

X

Address

City State Zip

Phone: Home Bus.

I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the USYS, its affiliated organizations and sponsors. Recognizing the possibility of physical injury association with soccer and in consideration for the USYS accepting the registrant for its soccer programs and activities(the Programs),I hereby release, discharge, and/or otherwise indemnify the USYS, its affilated organizations and facilities used 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.

Name

Signature X Date

I have received the Ohio Department of HealthConcussion Information Sheet for Youth Sports

Signature of Parent / Guardian: Date:

Bring to Tryouts:

1) A copy of your child’s birth certificate 2) Tryout paperwork which can be

found at freedom-na.com. Please complete all paperwork prior to arrival.

3) 1”x 1” head shot photo 4) Shin guards, water, and a ball

Questions: Contact Ian Peña freedomsoccr@yahoo.com

2017 Tryout Information Ian Peña Director of Coaching & Player Development US Soccer Federation "A" license

www.freedom-na.com Visit us for more information

• USSF “A” licensed director

• A focus on player development

• Club coordinated training curriculum

• Professional goalkeeping instruction for each age group

• Instruction by professional, licensed coaches who have extensive playing and coaching experience

• Placement opportunities for different skill levels

• Age appropriate league and tournament scheduling

• Winter training and indoor playing opportunities available

• US Youth Soccer o One National Champion o Two Regional Champions o Three State Champions

Registration begins at 5:30 PM Tryouts 6:00 to 7:30 PM except Saturday

Born 2010 U8 Girls & younger

Wed May 31st

Sat June 3rd

Born 2010 U8 Boys & younger

Wed May 31st

Sat June 3rd

Born 2009 U9 Girls & younger

Wed May 31st

Sat June 3rd

Born 2009 U9 Boys & younger

Wed May 31st

Sat June 3rd

Born 2008 U10 Girls &

younger

Wed May 31st

Sat June 3rd

Born 2008 U10 Boys &

younger

Wed May 31st

Sat June 3rd

Born 2007 U11 Girls &

younger

Fri June 2nd

Sat June 3rd

Born 2007 U11 Boys &

younger

Fri June 2nd

Sat June 3rd

Born 2006 U12 Girls &

younger

Fri June 2nd

Sat June 3rd

Born 2004 U14 Boys &

younger

Mon June 5th

Wed June 7th

Sat June 10th

Born 2005 U13 Girls &

younger

Mon June 5th

Wed June 7th

Sat June 10th

Born 2003 U15 Boys &

younger

Mon June 5th

Wed June 7th

Sat June 10th

Born 2004 U14 Girls &

younger

Mon June 5th

Wed June 7th

Sat June 10th

Born 2002 U16 Boys &

younger

Tue June 6th

Fri June 9th

Sat June 10th

Born 2003 U15 Girls &

younger

Tue June 6th

Fri June 9th

Sat June 10th

Mon-Fri Times:

Registration begins 5:30 PM All Ages – 6:00 - 7:30PM

Sat Times:

Born 2008-2010 2002-2005 8:30AM - 10:00AM

Born 2006-2007 1999-2001 10:00AM - 12:00PM

Born 2002 U16 Girls &

younger

Tue June 6th

Fri June 9th

Sat June 10th

Born

1999-2001 U17/18/19

Girls & younger

Tue June 6th

Fri June 9th

Sat June 10th

Attendance at all sessions recommended

Tryouts will be held at: Hylen Souders Elementary 4121 Miller Paul Road Galena, OH 43201

MOSSL, BPYSL, OSSL and MRL

The Freedom Soccer Club is sponsored in the Mid-Ohio Select Soccer League by the Big Walnut Soccer Association.

If you are looking for a club where skills are nurtured and player development is the focus, then the Freedom Soccer Club is the club for you!