Sign up for Micro Soccer - Fall 2009

Session run September 21^st -October 26^th

6:30-7:30 p.m. at Basehor Sixth Grade Center Fields

Player name___________________________________

Birthdate______________ ____________Age________

Address__________________________

City________________________State____Zip________

Mother/Father__________________________________

Cell phone______________________________________

E-Mail address__________________________________

Emergency contact______________________________

Emergency phone_______________________________

I, the parent or legal guardian  of the registrant,

Agree that I and the registrant will abide by the

rules of the YSYSA, it’s affiliated organizations

 and sponsors.  Recognizing the possibility of physical

 injury associated with soccer and in consideration

 for BLSA accepting the registrant for it’s soccer

programs and activities.  I hereby release, discharge

 and/or otherwise indemnify BLSA, Basehor Linwood

 School District and coaches or volunteers against

 any claim by or on behalf of the registrant as a

result of the registrants participation in the Program.

 Parent or Legal Guardian

Signature_______________________________________

Date_______________

Send signed form and $55. To Basehor Linwood Soccer Association

PO Box 310, Basehor, KS  66007 by September 18, 2009.