Taughannock Soccer Club  Membership Application

Team Level (circle one)          U6           U8           U10         U12         U14         U16         U19
                 

 Name:  Last: ________________________________First:_______________________________

Address_______________________________________________________________________

Phone _________________________   Email address___________________________________

Birth date (mm/dd/yy): __________ Gender:    M       F     School grade: ____ Years soccer: ____

Father: ________________________ Work phone: _____________    

Mother: _______________________ Work phone: _____________     

Would you help?   Coach__  Assistant Coach ___ Manage __ Fundraise ___ Field Maintenance___

Emergency Contact Name (other than parent): ____________________ Home phone: __________

Relationship:  _____________________________________________ Work phone: ___________

Physician: ___________________________________________     Phone:  __________________

List any allergies or medical conditions: _______________________________________________

I, the legal guardian of the applicant (“player”), recognizing the possibility of physical injury associated with soccer and in consideration for the Taughannock Soccer Club (TSC) accepting the applicant into its soccer programs and activities, hereby release, discharge, and/or otherwise indemnify the TSC, its affiliate organizations and sponsors, their employees and association personnel, including the owners of fields and facilities used for TSC programs, against any claim by or on behalf of the applicant as a result of the applicant’s participation in TSC programs and/or being transported to or from the same, which transportation I hereby authorize. The above applicant and 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 life, limb, or well being of my dependent. I accept responsibility for payment of any such services provided.

         We, the player and legal guardian of the player, agree that we will abide by the rules of the TSC, its affiliated organizations and sponsors. We will conduct ourselves in a sportsmanlike manner whether as player or spectator, and accept that any form of physical or verbal behavior and demeanor that is not consistent with fair and friendly play will not be tolerated. We recognize that youth players are developing and as such need encouragement and learn best from good example. We will recognize and applaud all players and their efforts regardless of team. We will act respectfully toward coaches and officials; accepting that positive comments are welcome.

 Signature of Parent/Guardian  _________________   Date : _________________

 Annual membership fee ($25)  ______     (Program fees are additional and vary with the program.)

Make checks payable to Taughannock Soccer Club, Inc.
Mail to:  Taughannock Soccer Club, P.O. Box 84, Trumansburg,  NY  14886