East Elgin Youth Soccer

Parent Information

Phone Number *

E-Mail Address *

Name of Parent/Guardian #1 *

Name of Parent/Guardian #2

Street Address *

Town/Municipality *

Rural 911#

Postal Code *

Volunteer

Parental Volunteers

The youth soccer program depends on strong support and assistance of Parent Volunteers, without which there would be no program. Please consider how you might contribute your time and talents to help deliver the soccer program during the upcoming year.

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League

Other

Player Information

(Please provide any additional information the Club/Coaches should be aware of e.g. allergies)

Rates: $60/per child | $200 for 4 or more children

Player Information

1	First name * Last name * Date of birth * Select gender Comments Indicate any comments including important medical information, requests to coach your children or other relevant information.
1	First name * Last name * Date of birth * Select gender Comments Indicate any comments including important medical information, requests to coach your children or other relevant information.

Add Player

Agreement and Consent

I the undersigned parent or legal guardian of the above named minor(s), do hereby consent and agree that they may participate in the House League Program of East Elgin Soccer. It is agreed that EEYS and its sponsors assume no responsibility for injury as a result of such participation. It is further agreed that all rules,
regulations and codes of conduct will be followed by players(s) and parent(s).

Digital Signature *

Provide the name of the person filling out this form. Submitting this form constitutes agreement to the terms above.

Payment

Credit card:

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Youth Registration