JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
RYSA Online Registration Form-2017
Thank you for helping the Revelstoke Youth Soccer volunteers speed up the registration process by completing this online form.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Player Information:
Last Name of Player
*
Your answer
First Name of Player
*
Your answer
BIRTH DATE
*
MM
/
DD
/
YYYY
GENDER
*
Please check the appropriate box.
Male
Female
Required
Contact Information for Player:
Email Address
For the Parent/Guardian of the player
Your answer
Mailing Address
*
Street and/or PO Box
Your answer
City
Revelstoke
Other:
Province
BC
Other:
Postal Code
V0E 2S0
V0E 2S1
Other:
Emergency Contact Information: Primary
Name of Parent or Guardian
*
This person will be the primary contact for RYSA in the case of an emergency.
Your answer
Relationship to the Player
*
Your answer
Phone 1 for the primary contact:
*
Home, Work, or Cellular number for primary contact.
Your answer
Phone 2 for the primary contact:
Is there a second number that RYSA can try?
Your answer
Emergency Contact Information: Secondary
Name of Secondary Contact
*
Who should we call if we can't reach the primary contact?
Your answer
Relationship to the Player
*
Your answer
Phone for the Secondary Contact:
*
Home, Work, or Cellular #
Your answer
Phone 2 for the Secondary Contact:
Home, Work, or Cellular #
Your answer
Medical Information
CareCard Number
*
Your answer
Does the player have a drug allergy?
Yes
No
Clear selection
If you answered 'yes', please explain in the space provided.
Your answer
Does the player have a food allergy?
Yes
No
Clear selection
If you answered 'yes', please explain in the space provided.
Your answer
Does the player have another allergy?
Bee stings, peanut butter, dust, grass, etc.
Yes
No
Clear selection
If you answered 'yes', please explain in the space provided.
Your answer
Does the player have asthma?
Yes
No
Clear selection
If you answered 'yes', please explain in the space provided.
Your answer
Does the player have diabetes?
Yes
No
Clear selection
If you answered 'yes', please explain in the space provided.
Your answer
Does the player have epilepsy?
Yes
No
Clear selection
If you answered 'yes', please explain in the space provided.
Your answer
Does the player require any medications on a regular basis?
Yes
No
Clear selection
If you answered 'yes', please explain in the space provided.
Your answer
Does the player wear contacts?
Yes
No
Clear selection
Fee Information and Final Confirmation
Registration Fee Information:
*
Please note: The RYSA is NOT collecting any money online. This registration is not complete until the applicable fees are paid.
I am aware that this registration is not complete until fees have been paid at one of the Soccer Registration Nights at the Community Centre (Thurs, Feb 16th OR Tues, Feb 21st)
I have read, understood, and will abide by the BC Soccer 'Fair Play' Guidelines available on the RYSA website.
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
