EXTRA Player Application
Player application for the Jurupa AYSO Region 462 EXTRA program.
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Email *
Prerequisites for submitting an application to play in this program:
Must be willing to make AYSO the priority non-school activity if selected. This is a time-intensive program that requires a full commitment and participation from each parent.
Player's First Name *
Player's Last Name *
Gender *
Division Requested (Only those listed are available) *
Played AYSO Previous Season? *
Preferred Field Position *
Trying out for Goalkeeper? *
Dominant foot? *
Number of seasons played? *
Parent/Guardian Information
Enter the information for the primary parent bringing the child to the try outs.
Parent's First Name *
Parent's Last Name *
Address *
Phone Number *
Volunteer position held last season/year? (N/A if none) *
Willing to referee (will become certified if not)? *
*The answer to this question does not affect your child’s score but helps the region determine if we can put together a team. Each EXTRA team must have at least eight referees (at least two must be a center referee), a coach, assistant coach and team manager.

WAIVER & RELEASE OF LIABILITY

I understand that there are risks involved with my child’s participation in the Jurupa AYSO EXTRA competitive soccer tryouts. 

I hereby waive and release the officials, coaches, and directors of Jurupa AYSO from all liability and agree to accept all medical expenses incurred. I know of no physical or mental problem that will affect my child’s ability to safely participate in these tryout sessions.

I certify that my child is in good health, and may participate in strenuous physical activities at the tryouts. I certify that there are no physical limitations to my child’s participation in the tryout or practice session. Permission is granted for my child to receive emergency medical treatment if needed.

I acknowledge and accept that this Release and Waiver is intended to be binding on the family, estate, heirs, executors, administrators and assigns of the minor named above. I further acknowledge and accept that this Release and Waiver is intended to be as broad and inclusive as permitted by the laws of California and agree that if any portion of this release and Waiver is invalid, the remainder will continue to be in full force and effect.

 *
Required
Family Acknowledgement
I understand and acknowledge that EXTRA is a competitive soccer program and that playing in the EXTRA program requires a significant commitment of time and effort. It also includes additional costs. Players are expected to attend practice, games (could be any day of the week), and support and cooperate with teammates and coaches. Parents are expected to participate with team volunteer commitments to Jurupa AYSO.
Signature part one: Please write your full name in the space provided *
Signature part two: Please check the box to e-sign this application
 *
Required
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