YDP Spring 2024 | Ithaca Youth SA

IYSA YDP

Registration Form

(Ages 3 - 6)

Please fill out all required (*) fields below and click on "Proceed to Checkout"

Players First Name

Players Last Name

Players Birth Date

Player Gender

Female

Male

Prefer Not to Say

Parent/Guardian Name

Primary Email

Primary Phone Number

Street Address

City

State (ex. NY)

Zip Code

Seconday Parent/Guardian

Secondary Phone

Seconday Email

Informed Consent Policy and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by the Ithaca Youth Soccer Academy during the selected season. In exchange for the acceptance of said child’s enrollment in the Club programs, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the Ithaca Youth Soccer Academy and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against the Ithaca Youth Soccer Academy, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including soccer

I, as parent/guardian with legal responsibility for this participant, do acknowledge my responsibility to restrict my child from play or practice if they exhibit any symptoms of COVID-19, and consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

I accept terms & conditions of Informed Consent Policy

I have read and understand the IYSA Player and Parent code of conduct

Photography Consent

Ithaca Youth Soccer Academy would like the ability to include team photos for website, social media promotion, and advertising of our youth soccer programs in our community.

We ask that you, the parent or legal guardian of the above registered player, grant IYSA use of any team soccer photographs for legal use, including but not limited to: publicity, copyright purposes, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use

I approve use of my child's photo

I do not approve use of my child's photo

List known allergies or medical conditions

Send Note to Coaches