EmailMe Form - Ohio North Youth Soccer Association: OUT-PL Form

This form must be completed by all players requesting permission to play with a state association other than the state in which they reside as well as by any player moving from one state association to another during the Seasonal Year. It may also be used to obtain a tournament guest player pass for those who are not already currently registered in the OHIO NORTH Affinity system.

Seasonal Year *

A Seasonal Year is September 1st thru August 31st

Player Name *

First Last

Player D.O.B. *

MM / DD / YYYY

OHIO NORTH Member ID

OHIO NORTH Member ID is unique to each registrant. If you do not know, please leave blank.

Gender *

Age Division *

Age division of the team that the player will be playing on.

Player Street Address *

Player City *

State *

Player Zip Code *

Guardian Name *

First Last

Guardian Email *

Confirm Email *

Guardian Phone # *

### - ### - ####

Please include the phone number where you can best be reached during OHIO NORTH office hours, 8-4 Monday through Friday.

Player Team: *

Out of State - Name of the team you will be playing on.

Guest Player - Name of the Team you will be playing with.

Player League: *

Out of State - The League Name that the team with be playing in.

Guest Player - League you play in if this is for a tournament request.

Out of State Request Summary

Please let us know why you are requesting out-of-state permission below.

Type of Request *

Interstate Permission (Player resides in one state, but wishes to play in another state association)

Relocation Release (Player moving from one state to another during seasonal year)

Tournament Guest player permission (Player will guest-play with a team from another state)

Tournament Guest player permission (Player will guest-play with a team from OHIO NORTH)

Home State Office:

Accepting State: *

State player wishes to particpate in.
If 'Other' is selected, designate below.

Other:

Birth Certificate Upload *

Please upload copy of player birth certificate PDF, JPG, WORD docs are accepted. You may also fax to: 440-526-9055 if preferred please contact Ohio North office.

Photo Upload *

For tournament guest player passes only. (jpg. format)

For Tournament Guest Player Requests ONLY

Please fill in the following information:

Tournament Name:

Start Date of Event:

MM / DD / YYYY

Location (City, State):

Guest Coach Name:

Guest Team Name:

Team Age Group:

__________________________________________

WAIVER of LIABILITY

By checking the boxes below, I the parent/guardian for the above child release, discharge and/or otherwise indemnify the organization/league/club for which I am registering the child to play, US Youth Soccer, the Ohio North Youth Soccer Association, its affiliated sponsors, employees and associated personnel, including the owners of fields and facilities utilized against any claim by or on behalf of the registrant as a result of his or her participation.

*

I agree to waiver of liability.

By checking this box and submitting this e-Registration form, I acknowledge that: I am the parent/guardian authorized to consent on the player’s behalf; I have reviewed this form and the information it contains and represent that it is accurate; and I agree to submit this form electronically with the intent to be bound by its terms and conditions.

GENERAL CONSENT for MEDICAL TREATMENT

By checking one of the boxes below, I give my consent to have an athletic trainer, coach paramedic, and/or doctor of medicine or dentistry provide medical assistance and/or treatment. I agree to be financially responsible for the reasonable cost of such assistance and/or treatment. This consent does not apply to major surgery unless surgery must be performed to treat an emergency condition. Attempts will be made to contact parents of players participating in the program based on information provided on this form.

*

I agree to consent for medical treatment.

By checking this box and submitting this e-Registration form, I acknowledge that: I am the parent/guardian authorized to consent on the player’s behalf; I have reviewed this form and the information in contains and represent that it is accurate; and I agree to submit this form electronically with the intent to be bound by its terms and conditions.

__________________________________________

OHIO NORTH PAYMENT

Payment must be sent to Ohio North for the request to be processed. NOTE: Membership with Ohio North is done annually. The annual seasonal year runs from the fall to the spring. Players are considered new members at the start of the new seasonal year.

Out of State or Guest Player Card - $25

Registration/Out of State Fees *

Player Registration $25

Payment will be sent via: *

Charge Card: I will submit payment by using an Ohio North Credit Card form with a copy of my order summary

Charge Card through Authorize.net: I will pay with a Credit Card through Authorize.net right now. (please note that after form is submitted, you will automatically be redirected to a payment screen.)

OYSAN APPROVAL STATUS:

Approved

Un-approved

Payment Status

Received By Ohio North