AYSO Region 630 Fall 2024 EXTRA Play Player Application

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Players that are invited and accept a position on an EXTRA Play roster will be expected to sign, with parent/guardian, an EXTRA Play Commitment and Obligation document. Those players that do not make an EXTRA Play roster will be continue to be registered for the regular Fall 2024 AYSO season in Region 630.

Email *

Parent/Guardian Name (First & Last) *

Parent/Guardian Email
*

Parent/Guardian Phone Number
*

Player Name (First & Last)
*

Player Date of Birth
*

YYYY

Division Applying For
*

Girls 9U (born in 2016)

Girls 10U (born in 2015)

Girls 11U (born in 2014)

Girls 12U (born in 2013)

Girls 13U (born in 2012)

Girls 14U (born in 2011)

Boys 9U (born in 2016)

Boys 10U (born in 2015)

Boys 11U (born in 2014)

Boys 12U (born in 2013)

Boys 13U (born in 2012)

Boys 14U (born in 2011)

Player Experience (include # of years played and at what levels -- e.g., Rec, All Stars, Club, Extra)
*

Player Preferred Position(s)

Player Goalkeeper Experience

No experience

Very experienced

Clear selection

Player Goalkeeper Interest

Interested in playing Goalkeeper full time

Interested in playing Goalkeeper some of the time

Willing to play Goalkeeper if the team needs it

Not interested in playing Goalkeeper

Other:

Clear selection

Names of Coaches for last Few Seasons

VOLUNTEER INFORMATION

A core component to the success of the EXTRA program is our parent volunteers therefore please let us know if you have been a parent volunteer in the past and if you are willing to be an EXTRA parent volunteer. All EXTRA teams are required to collect a specific number of referee points throughout the season in order to attend post season tournaments therefore volunteering to be a team referee can be a huge benefit to the EXTRA program and its teams.

Previous Parent Volunteer Role
*

AYSO Regional Referee or non AYSO Referee

Team Manager

Head Coach

Assistant Coach

None

Other:

Would you be willing to Volunteer As
*

AYSO Regional Referee or non AYSO Referee

Team Manager

Head Coach

Assistant Coach

None

Other:

IMPORTANT
*

I, the parent/guardian of the above mentioned player, a minor, BY CHECKING THIS BOX, agree that the player and I will abide by the rules of AYSO, its affiliated organizations and sponsors, specifically Region 630. Recognizing the possibility or physical injury associated with soccer and in consideration for the AYSO Region 630 EXTRA Play team accepting the player for team tryouts, I hereby release, discharge and/or otherwise indemnify the AYSO, their affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities, utilized for the tryouts, against any claim by or on behalf of the player as result of the player’s participation in the tryouts and/or being transported to or from same, which transportation I hereby authorize.,

Required

CONSENT FOR MEDICAL TREATMENT OF A MINOR
*

As the parent or legal guardian of the above named player, BY CHECKING THIS BOX, I hereby 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.

Emergency Contact Name
*

Emergency Contact Phone Number
*

Thank you for completing the Try-Out Registration Form

By submitting this document, Parents/Guardians and Player agree to all of its content.

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