To Be Completed At Registration
Tryout # _______
Check # _______ Ck Name_______________
Birthdate _____________ Age Group_____

2007-2008 JUNIOR IRISH REGISTRATION FORM AND RELEASE

Player Name: Date of Birth:
Player Address/City/State/Zip
Player Phone Number: Player E-Mail
Mother's Birth Day and Month (Exclude Birth Year)
(Required by Indiana Youth Soccer Association to create a unique registration number for each player.)
Father's Name                                 Phone Mother's Name                             Phone
Father's Occupation: Mother's Occupation:
Place of Work: Place of Work
Fathers E-Mail: Mothers E-Mail:
High School Playing In At Present? Grade Next Year: 
I would be interested in helping with the following activities: Please Check or Circle
Fund Raising Equipment/Uniforms Field Development/Maintenance Other
Willing To Be An Assistant Coach MDI Tournament-Volunteering is Mandatory
I agree to pay the required player's Fees at the time of registration tryouts.
Please check the level of travel you are interested in.  You may check more than one.
  I wish to compete at the Regional Level- Games played within the Northern part of Indiana against local travel clubs. (Northern Indiana Soccer League-NISL)
  I wish to compete at the State Level- Games played within Indiana or Chicago Metropolitan Area against top level state teams (Indiana State League - ISL, Central Indiana Youth Soccer League - CIYSL, Greater Indiana Regional League of Soccer - GIRLS, Northern Illinois Soccer League - NISL)
  I wish to compete at the National Level- Games played in Midwestern states against the best of state level teams, generally in Indiana-Kentucky-Ohio (Region 2 of the National League)
  I will play at any level.
Parents approval and medical release: recognizing the possibility of injury, both physical and mental, associated with soccer and soccer try-out procedures, and in consideration for the Junior Irish Soccer Club Inc. and its affiliates accepting the registrant for its soccer try-out program and associated activities I hereby release, discharge and otherwise indemnify the Junior Irish Soccer Club, inc., its affiliated organizations, and sponsors, their employees and associated personnel, including the owners of the fields and facilities used for the programs against any claim by or on behalf of the registrant as a result of the registrants participation in the programs and/or being transported to and from the same, which transportation I hereby authorize.
Signed Printed
Relationship to Child Date