GBSA Registration

Registrant First Name *

Registrant Last Name *

Boy or Girl *

T-Shirts Size *

Mailing Address *

Home Phone

Date Of Birth *

Month

Day

Year

Father's Name *

Father's Phone Number *

Mother's Name *

Mother's Phone Number *

Parent's email address *

Emergency Contact Person NOT Parent *

Emergency Phone Number *

Doctor To Notify *

Doctor's Phone Number

Medical Insurance

Med Insurance ID number

Any Medical Problem Of Athlete *

Medical Information

MEDICAL RELEASE INFORMATION 
I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Greater Binghamton Soccer Association (GBSA). Recognizing the possibility of physical injury associated with soccer and in consideration for the GBSA accepting the registrant for its soccer program and activities, I hereby release, and discharge and /or otherwise indemnify the GBSA, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrants participation in the GBSA program and /or being transported to or from the same, which transportation I hereby authorize. I further give my consent for emergency medical care prescribed by a duly licensed doctor of medicine or dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.

Code of Conduct (Coaches)

Code Of Conduct (Players)

Code Of Conduct (Parents/Spectators)

Parents/Spectators:
1. Are expected to have respect for the authority of the referee and their assistants. They will not harass, abuse, or berate during or after the match. They shall not enter the field of play without the referee’s permission.
2. Are expected to have respect for the coach and his/her assistants. They should never criticize a coach in a public manner. DO NOT coach from the sideline; let the coach do his or her job no matter how much you disagree. If there is a perceived coaching problem, talk to the coach offline.
3. Are expected to have respect for all players. Cheer in a positive manner, not negative. Encourage your team; do not berate the other team. Cheer in a way to reward the good lay of both teams and promote fair play.
4. Are not to use foul or abusive language towards anyone for any reason.
5. Have a responsibility to learn the laws of the game, and the spirit of the game.
6. Are encouraged to get involved with the organization and promote the game in a positive way.
7. Must demonstrate the utmost in sportsmanship and integrity; they are the role models for their
children.

Person Completing Form *

Email Person Completing Form *

Form Instruction

I have read and agree with the terms of this form *

I Agree

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GBSA Registration