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TUCKER YOUTH SOCCER ASSOCIATION
Spring 2009
Recreation Spring Break Camp for ages U9-U14
9AM-12PM or 9AM - 2pm
April 6 - 9, 2009 (Monday through Thursday)
Registration Form
Player
Name____________________________________________ Age___________
Parent/Guardian Name __________________________________________________
Address______________________________________________________________
Home
Phone______________________ Emergency Phone________________________
Email
(print clearly) __________________________________________________
Team
_______________________________________________
Playing
Position_________________________________
Coach_____________________________ Coaches Email _______________________
Health
Concerns_________________________________________________________
PARENTAL PERMISSION AND WAIVER
I, the parent/guardian of ____________________________________________,
hereby authorize the employees, representatives and/or designated agents of
TYSA Camp to act for me in their best judgment in any emergency that
requires medical attention for the above named minor. I hereby waive and
release all employees, representatives, and designated agents of TYSA Camp
and the Tucker Youth Soccer Association from any and all liability for any
injuries or illnesses suffered while participating in Spring Break Camp
2008. It is also understood that TYSA will not be responsible for any
damages caused by said minor or for loss or damage of any personal items or
property. It is understood that I must inform TYSA in writing, of any
special health or medical needs.
Signature of Parent/Guardian: _____________________________________________
Parent/Guardian Name________________________________Date: ______________
Complete registration form and mail it with payment to
TYSA Recreation Spring Break Camp
PO Box 354
Tucker, GA 30085
Camp
Fee: $90.00 Check #____________ Cash _____________ | 
