1. sports
2. softball

GREATER SOUTHWEST ATHLETICS
FALL SOCCER 2015
Registration DEADLINE JUNE 30
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 or attend a school located within the city limits & must be no younger than 6 years of age and no
older than 18 years of age as of 8/1/2015. 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. Players will be assigned to teams
through a draft; therefore, we may not be able to honor your requests for particular coaches or teammates. 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
___ / ____ /_______
*if birth cert is not on file- send copy

Sex
Address
Zip Code

Female
Home Phone
Parent/Guardian
Work Phone
Email Address(contact
email for GSA coach)
Cell Phone
School (Fall 2015)
Male
Mom:
Dad:
Mom:
Dad:
Age on AUG 1, 2015
Grade (Fall 2015)
Team Last Fall
Requested
Do you play travel soccer?
(2014 Team)
Team/ Coach
Give details of any disability that might hinder the above applicant from participating in GSA Soccer. Use additional sheet if necessary:


Yes
No
PARENTS: We need your help. Please volunteer for one of the following jobs:  Coach  Assistant Coach  Team Manager
Name:_________________________ Email address: _____________________________ Team: ______________Age Division: __________
Did you Coach or Asst. Coach last year? Yes  No 2014 Team Name:_________________ 2014Age Division:________________
Lack of sufficient number of coaches / volunteers may result in players not being able to be placed on a team.
AGE DIVISIONS: Please check the appropriate age/gender division for your child. Age determined on AUG 1 of current season. Participants 18
years of age must be enrolled in high school.Under no circumstances may a child play out of their age division
Boys:
Girls:
Eligible Birthdates:
 U - 7 Instructional Coed *
 U - 7 Instructional Coed *
8/1/2008—8/1/2009
 U - 8 Coed
 U - 8 Coed
8/1/2007—7/31/2008
 U - 10
 U - 10
8/1/2005—7/31/2007
 U - 12
 U - 12
8/1/2003—7/31/2005
 U - 14
 U - 14
8/1/2001—7/31/2003
 U - 17
 U - 17
8/1/1998—7/31/2001
 U - 19
 U - 19
8/2/1996—7/31/1998
UNIFORM SIZES: Please check "Youth" or "Adult" and check one size each for Jersey and Shorts
Jersey
 Youth
Shorts
 Youth
 Adult
 Small
 Medium
 Large
 Extra Large
 Adult
 Small  Medium  Large  Extra Large
REGISTRATION – 2 Options Registration must be with payment 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, VA 24014.
* If Birth Certificate copy is not already on file. Players beginning recreational sports must provide copy of birth certificate.
Do not leave this form with Parks and Recreation Dept. please mail to address above.
2. Register Online at:www.GSAsports.org with a Debit/Credit Card.
REGISTRATION DEADLINE: Forms received after JUNE 30, 2015, will be placed on a waiting list at the Athletic Director’s discretion and
cannot be guaranteed placement. There is a $10.00 LATE FEE. Each team roster is final at the start of the first scheduled match.
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
REGISTRATION DEADLINE: JUNE 30th, 2015