BYAA FALL ?

011 EOCCER SEASON SIGNUPS

The BYAA Fall 2011 Soccer Signups have begun" Please register bv June 30th. After this date players
will only be accepted to fil1 existing teams on a first come first serve basis and you will be charged alate
fee of $10"00 (there is no guarantee of your child being placed on a team roster after June 30e). To
assist in expediting registrations BYAA is offering o'register now, pay later'. Simply complete the
required forms and send them in to BYAA. Final payments can be sent later but must be received by
July 31't.

The registration fee will be $60.00 for the first child and $30.00 for each additional child (example I
child: $60.00, 2 children: $90.00,3 children $120.00 etc).
A separate $50.00 work bond check will be collected as well forthe concession stand. The work bond is
refundable upon your one time concession stand work.

Volunteers are also needed for coaches, assistant coaches and field maiatenance. Please mark the
appropriate box(s) on the registration form. There are a limited amount of these posilions available.
BYAA is a volunteer organization and only works smoothiy with adequate motivated volunteers.

The fall season is expected to start on September 10e and run through rnid November with all regularly
scheduled games on Saturday mornings/aftemoons. A uniform deposit will be collected when uniforms
are distributed in late August/early September.

To signup, complete a BYAA Registration and Medical Release Form for each child (2 pages each) and
send to BYAA with or without your two checks (registation$ and $50 work bond made out to BYAA)
and submit them to BYAA at:
BYAA
P.O. Box 231
Belvidere, NJ 07823

Additional information and the BYAA Registration and Medical Release Forms can be found at:
www.byaasports.com
www.belvidere green.com

For any questions please contact Mark Burton:

948-475-3398
mark.burton@bms.com

Please use the chart betrow to detemrine which soccer division your child will be in based on their birth
date (not school erade) and mark the appropriate box on the top of the on form.
Division Gendzr Birth Date Players on Field Ball Time of Half -Time
Rarpes [[oximun [tinimun Size Halves Break
2 Coed Priorlo t2/31/96x
3 rult-siaea o rlslBoys t/t/97 - 7/31/99* LI I 5 35 mins. 5-1O mins
4 G rls/Boys 8/t/99 - 7/31/Ot 11 8 4 35 mins. 5-I0 mins
5 G rlslBoys 8/t/01-7/31/03 8 5 4 25 mins. 5-10 mins
6 Coed 8/t/o3 -7/31/05 5 4 3 25mins. 5-10 mins
t Provided the player doesn't ploy for o High Schoolteom ot ony level (i.e., freshmon, Junior Vorsity, or Varsity)
Soccer Registration Form ficrinic [oi, e [oivs f] oiv +[ oiv a
Belvidere Youth Athletic Association (BYAA) vear:2011
NOTE: A $'10 iee will be assesed br late registrations. Msit www.byaasports.com fur regisfatk n dates and locations.
Uniform deposit ctteck is requircd.
$50.00 rvork bond iB required.
Voluntee[ E lvlanager E Assistant Manager REGISTRATION FEES:
fl Field Maintenane E Concession Stand $60.00 - 1 cHtLD $S0.00 - 2 CH|LDREN
$30.00 ADDIfloNAL FoR 3*o,4t*, gt*, ETc.
Please indicate if Certified:

Tdays dat€: Reglstration fee tohl: Make checks payable to: Gheck number: Receipt number
fl casn BYAA
PARTIGIPANT IilFOR]TATIOT{

Participanfs last name: First: Middle: Birth date: Sex:

tnfi,/dtl*yw EMale ilFemale

Street address Home phofte number: Secondary phone number:

uilrFoRr.l$ail.G$tART:
NJ Y(XttH: Y Small, Y Med, Y Large ADULT: A SrnalL A lled, A Large, A Xlarge
Did your child play travel soccer ifi the fall 2010
or spring 2011 seasons? Shirt size Pants size Height weight:

fi in lbs

PARE'{T'GUARDIAI{ INFORTiATI O'{

Fathefs(Guardian) flame: Mothefs(Guardian) name:

Fathefs address {if different from pa{ictpan0 Mother's address (f difierent from pariicipan0

Home phone number: Cell phone number: Do you text message? Home phone number Cell phone number Do you text message?

E-fittait2:

ET[ERGENCY AUTHORIZATION

Does the participant have a history of illness or allergi*? E Yes E tlo

lf yes, describe List any regularly taken medication: Name of participanfs doctor: Doctofs phone:

ln case of emergency, l^Aie hereby suthodze emergency trEaunent andor care of the above pafiicipant at any hospital.

lf in ail erheBEnc,y liwe cannot be reached, please contad: Relationship to participant Phone number: O(her phone number:

PAREIIT OR GUARDIAN AUTHORIZATION, DISCLAIIIER, AND WAIVER OF LIABILITY

As the parenUlegal guardian of (child's name), I give my approval for his/her participation in any and all aclivities during the cunent season for the sport indicated

to the ext{gili afld ifl the amount covered by the aecident-liability insurance carded by the Athletrt Association. I also, give my pennission for BYAA to take and use any
photograph or video/audio recoding whicfi my child appears for promotional purposes on the associslion website. I accept that iryouts may be tield when necessary for ieam
selec*ions based on league guidelines. I acknowledge and agree to the BYAA commitment and disciplinary policy posted at U'WW.BYAASPORTS.COI, and recognizes that
participation is subjec{ to the by-law8 established by the association.
E I oonsent to and attest to all the information on this form.

Date: Patientlcuardian signature

2011 Somr ReEiskation LAST REVISED 6/6/20U

 Belvidere Youth Athletic Association

Medical Release

NOTE; To be carried by any Regular Season or Toumament Team Manager

with team roster or eligibility affidavit

Player: Date of Birth:

League Name: Belvidere Youth Athletic Association sport-

Parent or Grrardian Authorization:
In family physician cannot be reache4 I hereby authorize my child to be
case of emergeney,if
treated by Certified Medical Personnel {i.e. EMT, First Responder, E.R. Physician, etc).

Family Physician: Phone:

Address:
Hospital Preference:

In Case of Emergeney Contact:

Name Phone hosre/cell Relationship to Player

Name Phone home/eell Relationship to Player

Name Phone home/cell Relationship to Player

Please list any allergies/medical problems, including those requiring maintenance

medications (i.e. diabetic, asthma, seizure disorder):

Medical Diasnosis Medication Dosage Frequency of Dosase

The purpose of the above listed information is to ensure that medieal personnel have details of any medical
problem which may interfere with or alter treatment

X Date:
Authorized Pare*UGuardiaa Signature

WARNING: Protective equipment cannot ptevent all iniuries a player might receive while participating in sports.