Player Registration

Household Information

Parent or Guardian's Name*

First Last

Phone*

Email*

Parent or Guardian's Name

First Last

Phone

Email

Home Address*

Street Address City State ZIP Code

Volunteer Information

Please mark all areas you would be interested in volunteering for.

Head Coach
Assistant Coach
Board Member
Concession (age 14+)
Referee (age 14+)

Concession Duty Opt-Out*

Would you like to opt out of your 2 hour concession stand duties for $20?

Yes
No

MYSA Certification*

Do you have your MYSA Certification?

Yes
No

Background Check*

When was your last background check? Include year only.

Coaching With

If you will have an assistant coach or will be an assistant coach, please tell us who you will be coaching with.

Volunteer Name*

First Last

Volunteer Email*

Volunteer Phone*

How many players will you be registering?*

1 Player
2 Players
3 Players

Player's Name*

First Last

Player's Gender*

Male
Female

Birthdate*

Coach's Name

If you are already on a team, please enter your coach's name.

Player's School*

Player Medical Conditions*

Please provide all medical conditions your coach should be aware of. If none, please put NA.

Ride Share Request

Please list SAME DIVISION AS PLAYER to be teamed with. Siblings take priority over friends and must be listed to be placed on the same team. Only ONE ride share may be listed. If more than one is listed, the first listed will only be accepted. Ride Share MUST MATCH on both player’s registration forms, and must be same gender. Coaches may not participate in Ride Share.

First Name Last Name

Player's Name*

First Last

Player's Gender*

Male
Female

Birthdate*

Coach's Name

If you are already on a team, please enter your coach's name.

Player's School*

Player Medical Conditions*

Please provide all medical conditions your coach should be aware of. If none, please put NA.

Ride Share Request

Please list SAME DIVISION AS PLAYER to be teamed with. Siblings take priority over friends and must be listed to be placed on the same team. Only ONE ride share may be listed. If more than one is listed, the first listed will only be accepted. Ride Share MUST MATCH on both player’s registration forms, and must be same gender. Coaches may not participate in Ride Share.

First Name Last Name

Player's Name*

First Last

Player's Gender*

Male
Female

Birthdate*

Coach's Name

If you will have an assistant coach or will be an assistant coach, please tell us who you will be coaching with.

Player's School*

Player Medical Conditions*

Please provide all medical conditions your coach should be aware of. If none, please put NA.

Ride Share Request

Please list SAME DIVISION AS PLAYER to be teamed with. Siblings take priority over friends and must be listed to be placed on the same team. Only ONE ride share may be listed. If more than one is listed, the first listed will only be accepted. Ride Share MUST MATCH on both player’s registration forms, and must be same gender. Coaches may not participate in Ride Share.

First Name Last Name

Agreements and Releases

Consent Agreement and Media Release*

I, the parent or legal guardian do hereby consent and agree that the above minor(s) may participate in the Washington Soccer Association Program in affiliation with the Franklin County and West County Soccer Leagues. It is agreed that the named associations or sponsors assume no legal liability for injures or any other loss as a result of participation. It is further agreed that the consent shall remain in full force and effect until such time as the undersigned parent or legal guardian shall notify the Washington Soccer Association in writing of the repeal or cancellation of this consent. Under NO CIRCUMSTANCES will refunds be available. I also give consent for photographs to be taken of the above player and used on the Washington Soccer Association website (washmosoccer.com) and their social media accounts.

I agree to the Washington Soccer Association Consent Agreement and Media Release

Code of Conduct - Player, Parent and Coach*

Participation in WSA is subject to all members obeying the Code of Conduct Rules set forth for all Players, Parents and Coaches. Washington Soccer Association is a not-for-profit 501(c)(3) organization. This organization is a private club governed by ten Directors (herein, The Board). As a private club, your affiliation is subject to adhering to the Code of Conduct Rules which the Board has set out for all parents, coaches and players. You should be familiar with the Code of Conduct rules for players, parents or coaches. Failure to adhere to these rules will, at the discretion of the Board, result in the scheduling of a mandatory disciplinary hearing in front of the Board. Rulings made at this hearing, failure to appear at a hearing and/or a repeat offense may result in you and/or your child being removed from participating in this club. ZERO TOLERANCE: Any player, parent or coach who conducts themselves in a manner found to be detrimental to the welfare of this club may be removed from participating in this club temporarily or permanently.

I agree to the Washington Soccer Association Code of Conduct

Payment Details

Registration Total

Below is your registration total for the upcoming soccer season.

$0.00

Credit Card*

Please enter your payment details.

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name