Online Registration Form        Home   


This Online Registration Form has been prepared to allow you to register your child online, simplifying the process.
All fields that have asterisks in front of them are required (if applicable) before your child is considered registered.

  1. Please describe the player you are registering (all fields with asterisks are required):

    *Name
    *Date of Birth mm/dd/yyyy
    *Sex Male Female
    Height X'X"
    Weight XXX
    *Soc. Sec. Number XXX-XX-XXXX (Needed for IYSA player passes)
  2. *Please indicate how old your child will be as of July 31st of this year?


  3. Enter your child's school system in the space provided below.


  4. *Has your child played for the club prior to this season?

    Yes No

  5. *Please indicate in the space below which year, season, and coach your child played in and for prior to this season.


  6. *How many years has your child been playing soccer (other than with KSC).


  7. *Which organization(s) has your child played with and how many years with each (note whether Rec. or Travel)?


  8. Please provide your contact information: (all fields with asterisk are required)

    *Name
    Organization
    *Street Address
    Address (cont.)
    *City
    *State/Province
    *Zip/Postal Code
    County
    *Work Phone xxx-xxx-xxxx
    *Home Phone xxx-xxx-xxxx
    FAX xxx-xxx-xxxx
    *E-mail
  9. Please provide contact information for spouse living seperately (fill in only if applicable):

    *Name
    *Street Address
    Address (cont.)
    *City
    *State/Province
    *Zip/Postal Code
    County
    *Work Phone xxx-xxx-xxxx
    *Home Phone xxx-xxx-xxxx
    *E-mail
  10. *Please indicate in the space below any medical information we may need to ensure the safety of your child (medications, injuries or conditions of note).


  11. *Knowing that KSC cannot exist without volunteers, indicate whether you would be willing to assist with the fields or concessions.


  12. Knowing that there is a substantial reduction in player fees for doing so, please indicate in the space below if you would be willing to assist with one of the teams or in the management of KSC (enter Coach, Asst. Coach, Manager or Board).


  13. *Indicate here that you are aware that a waiver must be signed and on file with the club and a Medical Release Form must be filled out and signed before your child can play.

    Waiver


Form custom-built by Randy Teachout.
Copyright © 1999 [Kokomo Soccer Club]. All rights reserved.
Revised: 09/07/03