SYA D Course 2013

The class is scheduled for July 26, 27, 28. The schedule will be finalized, and communicated.
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APPLICANT'S ADDRESS
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APPLICANT'S CONTACT INFORMATION
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APPLICANT'S EXPERIENCE
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METHOD OF PAYMENT
SIGNATURE
Please do not enter anything in the signature field as you will have to sign this form in person on the first day of the course.

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Being fully cognizant of the physical requirements of the Virginia Metro-DC Coaching Education Program, I am physically able to participate and hold the VCE, VYSA US Youth Soccer, and USSF, their coaching staff and each of their administrators, heirs, executors, successors, and assignors harmless for any injury or medical problem that might happen to me. I assume the risk of injury or medical problem, and I release and waive any claim that might be made by me or my heirs upon aforesaid.
EMERGENCY CONTACT
Note: The VYSA Accident Medical and Liability Insurance does not cover candidates participating in
VCE activities.
INSTRUCTOR'S EVALUATION
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