GREATER SOUTHWEST ATHLETICS
FALL FOOTBALL 2015
DEADLINE: Limited spaces available for each age division. Once an age division reaches the maximum players paid and registered, the
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registration for that division will close. If space remains available, the deadline is July 29 .
Player Eligibility
Practice & Game Season is August – early November
GSA, in partnership with Roanoke City Parks and Recreation Youth Athletics, provides recreational teams for Roanoke City players that reside in
Region IV, Southwest. To determine which of the four recreational clubs the organization for your residential area is, please contact Roanoke
City Parks and Rec (853-2236) or go to http://www.playroanoke.com/athletics/recreation-club-regions/
All participants must be Roanoke City residents and/or attend a school located within the city limits& must be no younger than 6 years of age by
October 1, 2015. All players must participate in their appropriate age group; no exceptions to this rule. If a sufficient number of coaches
are not available, we may not be able to honor your request for participation. Siblings in the same age group will be kept together upon request
Player Registration Form: Please print
Player’s Name
*Date of
Birth:MM/DD/YYYY
Sex
Address
Zip
Code
Parent/Guardian
___ / ____ /_______*if birth
cert is not on file at Parks &Rec- send
copy

Male

Female
Home Phone
1.
Work Phone
2.
Email Address(for GSA
coach to contact you)
Cell Phone
Mom:
Dad:
Mom:
Dad:
School (Fall 2015)
Grade(Fall 2015)
Age AS OF 10/1/15
Previous Age Division
Do you play travel Football  Yes  No
(2014 League)
Please use additional sheet to give details of any disability that might hinder the above applicant from participating in GSA Football.
*Birth Certificate:A copy of the birth certificate must accompany this registration if first time playing GSA sport and if not already on file with Roanoke City Parks
and Recreation.
PARENTS: We need your help. Please volunteer for one of the following jobs:  Coach  Assistant Coach  Team Manager
Volunteer Name:___________________________ Email address: _____________________________________
Did you Coach or Asst. Coach last year? Yes  No Previous Age Division/ League:_________________ (Biddy, Pee Wee, or Little League)
Lack of sufficient number of coaches / volunteers may result in players not being able to be placed on a team.
AGE DIVISIONS/ LEAGUES: Please check the appropriate league for your child
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Age cut off for Football is October 1 .
League:
 Biddy
 Pee Wee
 Little League
Age determined on October 1 of current season:
6 and 7 year olds
8 and 9 year olds
10 and 11 year olds
Eligible Birthdates:
10/1/2007 – 10/1/2009
10/1/2005 – 9/30/2007
10/2/2003 – 9/30/2005
Weight:
Unlimited
Unlimited
Unlimited
Middle School or High School Football~ for 12 years old on or before 10/1/15 or older. Leagues are run by Patrick Henry and William Fleming
High School Football Program.
UNIFORM SIZES:
1.Select Youth or Adult: Youth
 Adult
2. Select size: Small
 Medium
 Large
 Extra Large
REGISTRATION – 2 Options Registration must be with paymentbefore the age division is full or before the deadline to be accepted.
HOUSEHOLDS WITH OUTSTANDING FEES ARE INELIGIBLE TO PARTICIPATE WITH GSA REC SPORTS. Contact GSA to pay balance.
1. Mail this completed form with a check payable to GSA for $65.00, plus a copy of your child’s Birth Certificate* to:
Greater Southwest Athletics, 234 Parkcrest Street, SW Roanoke, Virginia24014
Do not leave this form with Parks and Recreation Dept. please mail to address above.
2. Register Online at:www.GSAsports.orgwith a Debit/Credit Card.
Registration Deadline: Limited space available for each age division. Once an age division reaches the maximum number of players paid and
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registered, the registration for that division will close. If space remains available, the deadline is July 29 , 2015. Forms received after the age
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division is full or after July 29 will be placed on a waiting list at the Athletic Director’s discretion.$10.00 LATE FEEfor registrations after the
deadline. Practice is scheduled to start the first week of August.
WAIVER
I hereby release RoanokeCity, Greater Southwest Athletics (GSA), and their directors, officers, employees, agents, and volunteers from liability with respect
to any injury or illness sustained by my registered child while participating in this program. I certify that the named participant, to the best of my
knowledge, is in good health and able to participate in the sport listed.
Parent/Guardian Signature
Date
GREATER SOUTHWEST ATHLETIC ASSOCIATION 904-6442
234 PARKCREST STREET, SW ROANOKE, VA 24014
Register online at www.GSAsports.org
DEADLINE: Limited space available for each age division and division will close when maximum number of players are paid and registered.
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If space remains available, the deadline is July 29 , 2015