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\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs28\kerning28\insrsid12727532 DRYDEN SOCCER CLUB}{\b\kerning28\insrsid12727532 
\par }{\b\kerning28\insrsid400739 RECREATIONAL LEAGUE 2006}{\b\kerning28\insrsid12727532  REGISTRATION FORM}{\kerning28\insrsid12727532 
\par }\pard \ql \li0\ri0\nowidctlpar\tqc\tx4320\tqr\tx8640\faauto\rin0\lin0\itap0 {\kerning28\insrsid12727532 
\par }\pard \qc \li0\ri0\nowidctlpar\tqc\tx4320\tqr\tx8640\faauto\rin0\lin0\itap0 {\b\kerning28\insrsid12727532 WEB SITE:  http://www.drydensoccer.org}{\kerning28\insrsid12727532 
\par League Member of New York State West Soccer Association
\par Affiliated with the United States Youth Soccer Association, United States Soccer Federation and FIFA
\par }\pard \qc \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\kerning28\insrsid12727532 Sponsored in part by the Town of Dryden Recreation Department
\par }{\b\kerning28\insrsid12727532  
\par 
\par  
\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\b\kerning28\insrsid12727532 Recreational Indoor Junior League - - }{\kerning28\insrsid12727532 the purpose of this program is to balance all play
ers onto teams in a fun, non-competitive league.  This is for children in fifth grade and lower.  The players are given equal time, in all positions, with no practices scheduled during the week.  Each week the teams play one 40 m}{
\kerning28\insrsid9783010 inute game.  The fee will be $22}{\kerning28\insrsid12727532  for a seven week session.  }{\kerning28\insrsid7745926 The program runs from January 7 through February 18}{\kerning28\insrsid400739 , 2006}{
\kerning28\insrsid12727532  in the Dryden }{\kerning28\insrsid7745926 High}{\kerning28\insrsid12727532  School }{\kerning28\insrsid7745926 gym}{\kerning28\insrsid12727532 .
\par 
\par }{\b\kerning28\insrsid12727532 Recreational Indoor Intermediate/Senior Leagues - }{\kerning28\insrsid12727532 the purpose of these two programs is to 
balance players from the senior high lever (grades 9-12), or the middle school level (grades 6-8), onto as many teams as is feasible in a more competitive structure.  Fun and kids playing are still the main goals.  The fee will be $32 for a}{
\kerning28\insrsid9783010  nine}{\kerning28\insrsid12727532  week session.  T}{\kerning28\insrsid9783010 hese leagues ru}{\kerning28\insrsid400739 n from January 7 through March 4, 2006}{\kerning28\insrsid12727532  in the Dryden }{
\kerning28\insrsid7745926 Middle}{\kerning28\insrsid12727532  School gym. 
\par 
\par }{\b\kerning28\insrsid12727532 PLAYER\rquote S NAME}{\kerning28\insrsid12727532   _________________________________________  }{\b\kerning28\insrsid12727532 DATE OF BIRTH}{\kerning28\insrsid12727532   _____________
\par 
\par }{\b\kerning28\insrsid12727532 PARENTS OR GUARDIANS}{\kerning28\insrsid12727532   ________________________________  }{\b\kerning28\insrsid12727532 JV or VARSITY EXP?}{\kerning28\insrsid12727532    ________
\par 
\par }{\b\kerning28\insrsid12727532 ADDRESS}{\kerning28\insrsid12727532   ____________________________________________  }{\b\kerning28\insrsid12727532 PHONE #}{\kerning28\insrsid12727532  _________________________
\par                      
\par                      ______________________________________  _____  }{\b\kerning28\insrsid12727532 EMAIL: __________________________
\par }{\kerning28\insrsid12727532 \tab \tab }{\fs20\kerning28\insrsid12727532 (please fill in entire address, including City and Zip Code)\tab \tab           (this REALLY helps your coach!)
\par 
\par }{\b\kerning28\insrsid12727532 PROGRAMS:}{\kerning28\insrsid12727532 \tab \tab \tab \tab \tab \tab \tab \tab   }{\b\kerning28\insrsid12727532 FEE}{\kerning28\insrsid12727532 \tab \tab }{\b\kerning28\insrsid12727532 DEADLINE
\par }{\kerning28\insrsid12727532 \tab 
\par \tab _____  Recreational Indoor \'93Junior\'94 Le}{\kerning28\insrsid14838481 ag}{\kerning28\insrsid7745926 ue (Grades K-5)\tab \tab $22.00\tab \tab    12/15}{\kerning28\insrsid400739 /05}{\kerning28\insrsid12727532 
\par \tab _____  Recreational Indoor \'93Intermediate\'94 Leag}{\kerning28\insrsid7745926 ue (Grades 6-8)\tab $32.00\tab \tab    12/15}{\kerning28\insrsid400739 /05}{\kerning28\insrsid12727532 
\par \tab _____  Recreational Indoor \'93Senior\'93 League}{\kerning28\insrsid7745926  (Grades 9-12)\tab \tab $32.00\tab \tab    12/15}{\kerning28\insrsid400739 /05}{\kerning28\insrsid12727532 
\par }{\kerning28\insrsid400739 
\par }\pard \qc \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid400739 {\kerning28\insrsid400739 WE REALIZE THESE DEADLINES SEEM EARLY, BUT WE HAVE TO ORDER SUPPLIES WELL AHEAD OF TIME BECAUSE OF THE HOLIDAYS.  THANK YOU FOR YOUR COOPERATION.
\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\kerning28\insrsid12727532 
\par Check payable to:  }{\b\i\ul\kerning28\insrsid12727532 Dryden Soccer Club}{\b\kerning28\insrsid12727532 , c/o Registrar, P.O. Box 277, Dryden, NY  13053
\par }{\kerning28\insrsid12727532 
\par \tab All members are encouraged to help in the Club\rquote s operation.  Is there a specific role you would like to fill in our Club?  The success of the programs offered are dependent upon parent volunteers.  Please consider one of the following options:

\par 
\par \tab \tab _____  Coach \tab \tab \tab \tab \tab \tab \tab _____  Assistant Coach
\par \tab \tab _____  Set up\tab \tab \tab \tab \tab \tab \tab _____  Referee
\par 
\par 
\par }{\kerning28\insrsid2372936 
\par 
\par }\pard \ql \li0\ri0\nowidctlpar\tqc\tx4320\tqr\tx8640\faauto\rin0\lin0\itap0 {\b\kerning28\insrsid12727532 SOCCER CLUB USE:}{\kerning28\insrsid12727532 
\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\kerning28\insrsid12727532 FEE:  ________     AMOUNT PAID:  ________     METHOD OF PAYMENT: ________    DATE:  ________
\par }\pard \qc \li0\ri0\nowidctlpar\tqc\tx4320\tqr\tx8640\faauto\rin0\lin0\itap0\pararsid6709695 {\b\kerning28\insrsid6709695 
\par }{\b\kerning28\insrsid8787832 DRYDEN SOCCER CLUB
\par }\pard \qc \li0\ri0\nowidctlpar\tqc\tx4320\tqr\tx8640\faauto\rin0\lin0\itap0\pararsid8787832 {\b\kerning28\insrsid8787832 P.O. Box 277, Dryden, NY  13053}{\kerning28\insrsid8787832 
\par }{\b\kerning28\insrsid8787832 http://www.drydensoccer.org}{\kerning28\insrsid8787832 
\par League Member of New York State West Soccer Association
\par Affiliated with the United States Youth Soccer Association, United States Soccer Federation and FIFA
\par }\pard \qc \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid8787832 {\kerning28\insrsid8787832 Sponsored in part by the Town of Dryden Recreation Department}{\pard\plain \qc \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid8787832 
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\kerning28\insrsid8787832 
\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid8787832 {\kerning28\insrsid8787832 
\par }\pard \qc \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid8787832 {\b\ul\kerning28\insrsid8787832 REGISTRATION / MEDICAL RELEASE FORM
\par Please Print Clearly and COMPLETE ALL Applicable Items
\par 
\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid8787832 {\b\kerning28\insrsid8787832 Name:}{\kerning28\insrsid8787832 \tab \tab Last  ______________________________   First  _______________________  Initial  _______
\par 
\par }{\b\kerning28\insrsid8787832 Address:}{\kerning28\insrsid8787832 \tab ____________________________________________________________________________
\par 
\par }{\b\kerning28\insrsid8787832 City:\tab \tab ________________________________   State:  ______________   Zip Code  ____________
\par 
\par Home Phone:\tab ___________________________ \tab \tab Alternate Phone:   ________________________
\par 
\par Email Address:  _________________________________  Jersey Size: YS  YM  YL  AS  AM  AL  XL XXL
\par \tab \tab      (this REALLY helps your coach)\tab 
\par Birthday: (mm/dd/yy)  _________\tab  Gender:     M    F     School  ______________  Grade in School   _____    
\par 
\par Father:  ________________________________\tab Telephone:  (H)_____________\tab (W)_____________\tab                  
\par 
\par Mother:  _______________________________\tab Telephone:  (H)_____________\tab (W)_____________
\par 
\par Physician:   _____________________________\tab Telephone:  ________________
\par 
\par Emergency Contact Name:  ____________________________________\tab Telephone:  ____________
\par 
\par }{\kerning28\insrsid8787832 List any medical problems we should know about:  _________________________________________________________________________________________
\par 
\par _________________________________________________________________________________________
\par 
\par }{\fs20\kerning28\insrsid8787832 I, the undersigned legal 
parent/guardian of the child listed below, hereby give permission for my child to participate in the Dryden Soccer Club and Town of Dryden Recreation Department sponsored program at my and his or her own risk.  I understand that there is }{
\fs20\ul\kerning28\insrsid8787832 NO}{\fs20\kerning28\insrsid8787832  supplemental }{\b\fs20\kerning28\insrsid8787832 accident insurance coverage }{\fs20\kerning28\insrsid8787832 
provided for participants in the program.  On behalf of myself, my child and any other guardian, I agree that we will abide by the rules and regulations of the program and will accept in good faith any and all decisions of the off
icials/person(s) in charge.  
\par Recognizing the possibility of physical injury associated with soccer and in consideration for The Club and the Town of Dryden Recreation Department accepting the applicant for its soccer programs and activities (\'93The Programs\'94
), I hereby release, discharge and/or otherwise indemnify its affiliate organizations and sponsors, their employees and association personnel, including the owners of fields and facilities used for The Programs, against any claim by or on behalf of the ap
plicant as a result of the applicant\rquote s participation in The Programs and/or being transported to or from the same, which transportation I hereby authorize.
\par 
\par This child has had a physical exam within the last year and there is no medical restriction(s) to prevent program participation.
\par I and the above applicant hereby give consent for emergency 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.
\par 
\par 
\par }\pard \ql \li0\ri0\nowidctlpar\tqc\tx4320\tqr\tx8640\faauto\rin0\lin0\itap0\pararsid8787832 {\fs20\kerning28\insrsid8787832 Signature of Parent/Guardian:  _________________________________________________          Date:  ____________________}{
\fs20\kerning28\insrsid8787832\charrsid8787832 
\par }}