Benicia Youth Soccer

AFFILIATES

Arsenal FC Player Tryout Form

Player Information

U9B	U10B	U11B	U12B	U13B	U14B
U9G	U10G	U11G	U12G	U13G	U14G

	U15B	U16B	U17B	U18B	U19B
	U15G	U16G	U17G	U18G	U19G

First Name:

Last Name:

Address:

City:

State: Zip:

Phone:

(Format: 916-555-1212)

Birth Date

(Format: 12/25/1992)

Field Position:

Forward Midfield Defense Goal Keeper

Club/Team Played on Last Season:

Parent Information

First Name:		Last Name:
Email Address:
Phone:		Cell Phone:
Address:
Mark here if address is the same as player's information
Street:
City:		State: Zip:

Emergency Information

Emergency Contact:
Emergency Phone:
Doctor to Notify:
Doctor Phone:

Parent/Guardian Waiver

I, the parent/legal guardian of the above-named player, a minor, or a player age 18 or over, agree that I and the player will abide by the rules and regulations of the U.S. Youth Soccer (USYS), and its affiliated organizations, and the California Youth Soccer Association, Inc (CYSA), and its affiliated organizations. I, for myself and the player and our respective heirs, administrators and successors, intending to be legally bound, hereby release and indemnify the USYS and CYSA Parties, the owners and operators or the facilities used for the programs, and their respective directors, officers, employees, agents and representatives from and against all claims, liabilities, damages or causes of action arising out of or in connection with the player’s participation in the Programs including, without limitation, player’s transportation to/from any Program, which transportation is hereby authorized. As the parent/legal guardian of the above-named player, or player age 18 or over, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of me or my dependent.

I Agree I Disagree

Age Chart
U9	8/1/01 - 7/31/03
U10	8/1/00 - 7/31/01
U11	8/1/99 - 7/31/00
U12	8/1/98 - 7/31/99
U13	8/1/97 - 7/31/98
U14	8/1/96 - 7/31/97
U15	8/1/95 - 7/31/96
U16	8/1/94 - 7/31/95
U17	8/1/93 - 7/31/94
U18	8/1/92 - 7/31/93
U19	8/1/91 - 7/31/92