MSYSA ODP Registration

MSYSA ODP Tryout Form
Fill out form below and press "Submit." All Caps NOT Accepted. Proper Punctuation Required.
Click Here to Read About Tryouts
Click Here to Read About 101 Camps

First Name:

Last Name:

Street Address:

City:

State:

Zip:

Phone Number:

Email Address:

Date of Birth:
//

Club Team Name:

High School Graduation Year:

GPA:

U.S. Citizenship?
Yes No

Position:
Field Player Goalkeeper Both

Registering For:

Age Group (based on birth year - for Tryouts only):

For 101 Tryout Only choose one site:
West (Grand Rapids Area)
Metro North (Oxford)
Metro Central (Northville), and
Central North (Mason)

Is Player Registered with a MSYSA Sponsored Team?Yes No
If not, $10 will be added to your Tryout Registration Fee or Tryout Camp Registration Fee for insurance. Any questions regarding insurance should be directed to MSYSA at 734-459-6220.

Tryout Registration Fee is normally $100 (if registered by June 30, 2010) or $125 (if registered after June 30, 2010). 101 ID Camp Registration Fee is $80.00 (if registered by June 30, 2010) or $100 (if registered after June 30, 2010).

Method of Payment:
Credit Card Check

If you selected the credit card option, please fill out the credit card payment information below.

Name on Credit Card:

Credit Card Type:
Visa
MasterCard

Credit Card Number:

Exp. Date:
/

Cardholder's Address:

Cardholder's Zip Code:

A parent or legal guardian must agree to the following statement:

I hereby authorize the Michigan Olympic Development Program to provide emergency medical treatment for my son/daughter should an injury occur during try-outs or subsequent practices. My son/daughter has had a recent physical examination and is physically capable of participating in try-outs. 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.

Please check over your information thoroughly before submitting.

Please click the Submit button ONLY ONCE.
Sometimes, it takes a few seconds for the form to be processed. Thank you.