South County Youth Association

Po Box 42, Shady Side, MD 20764

South County Youth Association
Online Registration
Participant Information
Enter participant’s information:
First Name: Last Name:
Birth Date: Gender:
  Special considerations
(medical conditions, participant limitations, etc.)
Registration Information s_id is
Please select one of the sports below
    Season     Sport     Level     Fee     Description of Fees     (scroll over sport level to the left for more information)
     If a sport is not listed above, registration is not open for that sport. Please check SCYA's List of Sports for registration opening and closing dates.
      If you need other information, please contact the sport's coordinator(s) for information on late/early registration.
   No uniform offered for selected sport    
The uniform options may not display properly if Java script features have been turned off
 Other Info
 School: Please enter "None" if child doesn't yet attend school.
 Grade: Please enter "Pre-K" if child doesn't yet attend school.
  Special requests
    (coach requests, teammate requests, etc.)
 Medical Information
Emergency Contact [relationship]: Emergency Contact Phone Number: ()  
2nd Emergency Contact [relationship]: Emergency Contact Phone Number: ()  
Physician: Physician's Phone Number: ()  
  Insurance Company: Insurance Phone Number: ()  
  Policy Holder's Name [relationship]:   Policy Number:
Family Information
Note: Email addresses, phone numbers, etc. will be used only to provide team/sports information from South County Youth Association. The data will not be provided to any outside entity or organization. Your phone number and email addresses may be made
private. Private information will not be available to
team mates on South County Youth Association online rosters.
Phone Number: ( )   Private
Email Address: Private
2nd Email Address Private
Street Address:
City: State: Zip Code:
Mother's Information (Parent’s Information is optional with the exception to enter at least one parent’s name.)
First Name: Last Name: Cell/Work Phone ()
Father's Information
First Name: Last Name: Cell/Work Phone ()
Parent Volunteer Information
Volunteer for:Coach Asst Coach Team Parent Field Maintenance Other
Volunteer Information:
   (name, details, requests, etc.)
 Concussion Awareness

Information on Concussions and Head Injuries is available on the AA County Concussion and Sudden Cardiac Awarness form. By checking the box to the left, the person submitting this form acknowledges receipt of this information as required to be made available by MD law.

 Photography and Videography Consent

By registering I give SCYA permission for this registrant to be photographed or videotaped and any such image or footage may be published to promote or publicize the sports program of SCYA. If you do not want this registrant to be used in any publication or promotion of SCYA please deselect checkbox.

Waiver and Consent
As the parent or legal guardian of the child being registered. I hereby give my full consent and approval for my child to participate as a team member in the South County Youth Association athletic programs. I understand that there are certain risks of injury inherent in the practice and play of this sport, as well as in traveling and other related activities incidental to my child’s participation and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in the designated sport and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these activities except as listed above.

In addition to giving my full consent for my child's participation, I do hereby waive, release and hold harmless the South County Youth Association, their officers, coaches, sponsors, supervisors, and representatives for any injury that may be suffered by my child in the normal course of participation in the designated sport and the activities incidental thereto whether the result of negligence or any other cause.
To register: Complete this form and click Register.

Be sure to review our Refund Policy.

Name of person completing form: To acknowledge waiver and submit registration, click the Register button.
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