ODP 101 Registration

ODP 101 Tryout Registration 

                    Be sure to submit all fields to register for the 2012/2013 MSYSA ODP Tryout. 

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Player First Name: Player Last Name: ODP Site to Attend: Grand Rapids- Brewer ParkMason- St. James ChurchOxford- Seymour Lake ParkTraverse City- Traverse City W. High School Gender: Male Female Player Birth Year: 200220032004 Player Month of Birth: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Player Date of Birth: 12345678910111213141516171819202122232425262728293031 Street Address: City: State: (Note you MUST be a Michigan resident to tryout for MSYSA ODP) Zip Code: Phone Number:  Enter a valid phone number. Example: 123-456-7890 Current Email Address: (Where information should be sent regarding tryouts)  Enter a valid email address. Example: name@company.com Player Graduation Year: 202020212022 Current Club: Position: Field PlayerGoalkeeper Are you a U.S. citizen? Yes No Is player registered with an MSYSA Sponsored Team? Yes No I hereby authorize the Michigan Olympic Development Program to provide emergency medical treatment for my son/daughter should an injury occur during tryouts or subsequent practices. My son/daughter has had a recent physical examination and is physically capable of participating in tryouts. I hereby release, discharge, and/or otherwise indemnify the MSYSA, its affiliated organizations and sponsors, their employees and associated personnel, including all volunteers and the owners of fields and facilities utilized by the program, against any claim by or on behalf of the registrant as a result of the registrant's participation in the program. I have read and agree to the above statement. I hereby grant MSYSA permission to use my likeness, or the likeness of my child in a photograph and/or video in any and all of its publications, including website entries, without payment of any other consideration. I understand and agree that these materials will become the property of the MSYSA and will not be returned. I hereby irrevocably authorize MSYSA to edit, alter, copy, exhibit, publish or distribute photos or videos for purposes of publicizing the MSYSA or for any lawful purpose. In addition, I waive the right to inspect or approve the finished product. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video. I hereby hold harmless and release and forever discharge MSYSA from all claims demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on on behalf of my estate have or may have by reason of this authorization. I have read and agree to the above statement. Last name on credit card: