Registration Form    BACK    HOME

This form enables you to register your child to the current Travel season.
Fields with an asterisk must be filled out.

  1. Please identify and describe the player you are registering:

    *Date of Birth
    *Sex Male Female
    *Soc Sec Number Needed for IYSA liability ins.
  2. *How old will your child be as of July 31st of this year?

  3. Please indicate which school system your child attends.

  4. Please provide your contact information (use alternate column for principle address of player):

    *Name   Alternate
    Spouse's Name

    Street address

    Work place


    *Street Address


    Address (cont.) Home Phone
    Zip/Postal Code    
    Work Phone    
    Home Phone    
  5. Has your child played soccer before?

    Yes No

  6. How many years of soccer experience does your child?

  7. List the organizations your child has played for prior to KSC?

  8. Has your child played for KSC before?

    Yes No

  9. List the year, season and coach that your child played for in the club prior to the current season.

  10. Please indicate which area you would be willing to volunteer in: (Field Maintenance or Concession Stand)

  11. Please indicate any medical conditions, injuries or medications that are currently affecting or have recently affected your child.

  12. Understanding that there is a substantial reduction in player dues for these positions, would you be willing to assist with coaching or managing a team, or with Club operations? If so please indicate which here.

Author Randy Teachout.
Copyright © 1999 [Kokomo Soccer Club]. All rights reserved.
Revised: 06/03/02