Registration Form Cost: $40. 00/player or $110. 00/family of 3 or more

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TuriRegistration form

Burgettstown Area Youth Soccer Association – Fall 2010 Season

Mail to: BAYSA, c/o Ron Osborn, PO Box 239, Langeloth, PA 15054

Registration Form

Cost: $40.00/player or $110.00/family of 3 or more

Payment is required at time of registration – Make checks payable to BAYSA

Player Name:



Circle: Male Female



Street Address:






Emergency Contacts:


Relationship to Player:

Select Division:

______U6 8/1/2004 to 7/31/2006

______U10 8/1/2000 to 7/31/2002

______U14 8/1/1996 to 7/31/1998

______U8 8/1/2002 to 7/31/2004

______U12 8/1/1998 to 7/31/2000

______U15 8/1/1995 to 7/31/1996

Injury Waiver: I recognize and understand that soccer is a sport involving risks not encountered in everyday play. With that understanding, in consideration of BAYSA permitting my child to participate in their soccer program, I covenant and agree to indemnify and hold harmless and do release, requite and forever discharge BAYSA, its Officers, coaches, referees and other such volunteers as are connected with BAYSA in any capacity, for any and all damages, claims and/or liabilities arising out of any and all injury to or caused my child. With the knowledge and understanding of the foregoing, this is to certify that my child has my permission to play soccer in the BAYSA program.

Parent/Guardian Signature: _________________________________ Date: _____________

Medical Consent: I hereby authorize any and all emergency medical treatment deemed necessary for my child by a physician, nurse or paramedic. A copy of this authorization shall be as effective as the original.

Parent/Guardian Signature: _________________________________ Date: _____________

Website Photo Consent: I do hereby agree to allow my child’s photo to be taken, obtained and used on the BAYSA website without compensation to me or my child. I understand that my child's name will not be listed with any of the photos displayed on the BAYSA website.

Parent/Guardian Signature: _________________________________ Date: _____________

New Jersey Order Form

ALL PLAYERS MUST HAVE A JERSEY to participate in Saturday games. Jerseys are ordered by BAYSA.

Cost: $25.00

This cost is in addition to the registration fee. Payment is required at time of registration. Make checks payable to BAYSA.

We suggest you order large. Leave room for a sweatshirt underneath for cold days. This brand of jersey DOES NOT run large.

Player Name:




Select Size:

______YS (6-8)

______YM (10-12)

______YL (14-16)

______AS (34-36)

______AM (38-40)

______AL (42-44)

______AXL (46-48)

______AXXL (50-52)

Jersey Exchange Option

To help keep soccer affordable for everyone, BAYSA is implementing a jersey exchange program for clean (gently used) jerseys. If you need a jersey for the soccer season, you must still submit your order for a new jersey with the $25 payment. If your request for a used jersey can be filled, the cost difference will be refunded to you when jerseys are distributed.

Select all that apply:

_____ Exchange: I would like to exchange my size ______ jersey for a size ______ at no cost, if one is available*

_____ Purchase: I would like to purchase a size ______ jersey for $10.00, if one is available

_____ Donate: I have a size ______ jersey I will donate to the exchange program*

*Clean (gently used) jerseys will be collected at the following WALK-IN registration events only:

  • Avella Area Library on Sat, July 24 from 10 am - noon and 2 - 4 pm and Wed, July 28 from 5 - 7 pm

  • Burgettstown Community Library on Tues, July 20 from 6 - 8 pm and Sat, July 31 from 11 am - 1 pm

  • Heritage Public Library on Sat, July 24 from 10 am - noon and Thurs, July 29 from 6-8 pm

Volunteer Form

BAYSA IS A VOLUNTEER ORGANIZATION. All activities require volunteers. Each family will be assigned a concession shift.  Please check below all other areas where you can help to keep our organization running:

Player Name:

Volunteer Name:




______Field Line Painting - Before Sat. Games

______U14 8/1/1996 to 7/31/1998

______Asst. Coach

______Field Cleanup & Trash Disposal – After Sat. Games

______U15 8/1/1995 to 7/31/1996

______Occasionally Available, Contact to Ask for Help

Volunteers 18 and over who have regular contact with minors are required to have a current PA West Soccer background check, OR must provide a current Act 33/34 clearance. Background checks are not required for occasional volunteers. BAYSA will provide information on how to get a PA West Soccer background check and will reimburse the background check fee with proof of payment.

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