Youth Soccer Registration

Closed

Player First Name

Player Date of Birth

Player Last Name

Jersey Size

Player Gender

Comments / Concerns / Medical Information (e.g. allergies)

Address

City

Parent 1 First Name

Parent 1 Phone Number

Parent 2 First Name

Parent 2 Phone Number

Postal Code

Parent 1 Last Name

Parent 1 Email

Parent 2 Last Name

Parent 2 Email

Parent coaches are an indispensable component of our programs. At ESRA we recognize and value those parents who volunteer to coach by offering a refund of soccer registration fees upon return of the equipment at the end of the season. Ideally each team will have a Head Coach and Assistant Coach. Please consider signing up for one of these roles!

I am willing to volunteer for the following roles (check all that apply):

Head Coach

Assistant Coach

Referee (11 and up)

Name of Coach/Ref

By submitting this registration, you acknowledge that there are certain risks of damages and injuries, including death, inherent in the practice and play of all sports, as well as in travelling and other related activities incidental to your child’s participation. You are willing to accept these risks on behalf of your child. These risks include, but are not limited to, hazards associated with weather conditions, travel, playing conditions, equipment and other participants.

I acknowledge and accept the aforementioned risks.

Thanks for submitting!