OSC Summer Registration Form

If adding more than one child, you will submit each child separately, after you submit the form it will reset, just submit it again with the next child's information

Parent Information

Parent Full Name:
Address:
City:
State:
Zip:
Phone:
Email:

Child Information

Child First Name:
Child Last Name:
Sex:
Birthdate: Which Age Group is My Child In?

Shirt Size (if applicable):
List Any Medical Issues:

Emergency Contact Number:

Parental Consent

By placing your signature below & checking the box I agree:

The age / birthdate information indicated for all registrants is true and accurate.
As the parent / legal guardian of the player(s) in this registration, I hereby give consent for emergency
medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be
given under whatever conditions are necessary to preserve life, limb or well being of my dependent(s).

I also agree as well as the registrant(s), to abide by the rules of the USYSA, its affiliated organizations
and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration
of the USYSA, accepting the registrant(s) for its soccer programs and activities I here release, discharge
and/or otherwise indemnify the USYSA, its affiliated organizations and sponsors, their employees and
associated personel, including the owners or fields and facilities utilized, against any claim by or on
behalf to the registrant(s) as a result of the registrant's in the program and/or being transported to and
from the same, which transportation I hereby authorize.

I also agree to adhere to the Olean Soccer Club Parent Agreement

I Agree to these terms.
Parent Type Name Here:

Special Requests (Requests are honored when possible, but not guaranteed):

I Would Like to Help OSC by: