Register for the Fall 2010 Rec League Season

Please complete this form
All fields required except where marked optional

Player's First Name     Last
Parent's First Name     Last
Street Address  
City     State   Zip 
Township or Borough  
School  
     
Home Phone               Cell optional
Primary e-mail  
Secondary e-mail optional  
     
Date of birth / /
     
Are you paying by check
or credit card?		   Check    Credit Card    
     
If paying by credit card, what name is on the credit card  
     
Gender   Female    Male    
     
Player wishes to play:   Coed    Girls only
  
 Player's soccer experience     < 2 Years      2 to 4 Years   5 Years or more
  
Do you need to order
a reversible jersey?
Required for 7 to 17-year olds		   Yes    No
If so, what size?
 		   Youth Large Adult Small Adult Medium  
Adult Large       Adult Extra Large
     
Parent, would you like
to volunteer? You can check more than one box. optional		   Coach      Asst. Coach     Age Group Coordinator
     
I can't coach,
but I'm willing to help by: 		 
   

RELEASE STATEMENT:
I, the parent/guardian of the registrant, a minor, or adult registrant of legal age, agree that I and the registrant will abide by the rules of EPYSA, its affiliated organization, and sponsors.  Recognizing the possibility of physical injury associated with soccer and in consideration for the EPYSA accepting the registrant for its soccer programs and activities, I hereby release, discharge and/or otherwise indemnify the EPYSA, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the programs, against any claims by or on behalf of the registrant as a result of the registrant's participation in the program and/or being transported to or from the same, which transportation I hereby authorize.  I have read this application completely, including the first Web page of this registration, and give my permission for my child to play soccer in the Southern Chester County Soccer Association.

A player may not play without agreement to this release

I agree to the release 
I do not agree to this release 

After you submit this form, (1) you'll get a confirmation page that includes an order form for a reversible jersey. (2) Please print that page and (3) mail it in along with your payment.