Player's legal name:_______________________________________ Birth date:_____________

Address:(street) ____________________________________ (mailing) P.O. Box_____________

City:___________________ State of WA Zip: _______          City: _________, WA Zip ________

School:______________________________ Grade: _________________ Current age: ______

Parent/Guardian: ______________________________ Relation to player: ________________

Address: ___________________________________________________ if different from player

Home phone: ________________ Work Phone: ________________ Cell phone: _____________

E-mail: ______________________________________

Previous Team Name:______________________________ Previous Coach_________________

Do you wish to play on the same team, different team, with kids from the same school, with kids your

 own age, with older kids. With player named: __________________With coach named: _________

CONSENT AGREEMENT:

I hereby consent to the participation of the player named above in Thurston County Youth Soccer Association and their

affiliated clubs; Chinqually Booters Soccer Club, Olympia Youth Soccer Club, Prairie Soccer Club, Tumwater Soccer Club

and Westside Soccer Club activities.  These activities include practices, games, tournaments or other activities authorized by

Washington State Youth Soccer Association (WSYSA). I hereby agree to waive, on the behalf of my child, any and all claims

for damages resulting from my child's participation in Thurston County Youth Soccer program activities; against my child's soccer

team; its coaches; managers and sponsors, Thurston County Youth Soccer and its affiliated clubs, assigned referees and officials,

except as limited to the recovery specified in the insurance policy provided by the Washington State Youth Soccer Association

to each player as part of the registration fee collected by the individual clubs.

Parent/Guardian Signature: ______________________________ Date: ______________

FOR EMERGENCY MEDICAL AUTHORIZATION

This is to certify that the bearer of this letter has the permission of the undersigned to authorize necessary

emergency medical care by the attending medical provider or others they may choose in care of accidental

injury, ingestion or illness.

Player name: ___________________________________ Home phone: ______________

Player's Parent/Guardian: _________________________________ Cell phone: ______________

Emergency contact: _______________________________Phone number: ________________

Relationship to player:_______________________

Physician's name:____________________________ Phone number: ________________

Insurance Company: _____________________________________________________

Policy number: _______________________________

Allergies: _______________________________________

Special medical conditions: _________________________________________________________________

Parent/Guardian Signature: __________________________________________ Date:_______________

This form can be mailed to any of the clubs affiliated with Thurston County Youth Soccer Association.

Chinqually Booters Soccer Club            Olympia Youth Soccer Club            Prairie Soccer Club

P.O. Box 3935                                              P.O. Box 1683                                    P.O. Box 1901

Lacey, WA 98509                                       Olympia, WA 98507                        Yelm, WA 98597

Tumwater Soccer Club                            WestSide Soccer Club

P.O. Box 14304                                        c/o Thurston County Parks and Recreation

Tumwater, WA  98511 -4304                    2617-A  12th Court SW

                                                                     Olympia, WA  98502

Clubs are organized geographically.  Chinqually is for players attending Lacey Schools,  Olympia is for players attending Olympia

Schools. Prairie is for players attending Yelm, Rainier, McKenna or Roy Schools, Tumwater is for players attending 

Tumwater Schools and Westside is for players attending West Olympia Schools.  Each club charges a different fee for playing

 summer soccer based on their cost of field use.  Make your check payable in the amount indicated for that club.

 .

For Chinqually, make your check payable to CBSC in the amount of $55.00

For Olympia, make your check payable to OYSC in the amount of $45.00

For Prairie, make your check payable to PSC in the amount of $42.00

For Tumwater, make your check payable to TSC in the amount of $45.00

For West Side, make your check payable to WSC in the amount of $45.00