Public Registration

NOTE - if you are registering siblings, please do so separately.

NOTE - if you are registering twins, please do so separately and change the birthdate for the 2nd child by three days. This is to avoid our database over-writing the first child.

8-date Public Programs are $152 before March 22. After March 22, the price is $162.

All Ages (3 to 6) may be registered for any program

If you do not see the program you would like to enroll in, it is because it is full and we’re no longer accepting registration for it

Fields with a * are required.

Participant's FIRST Name:*

Participant's LAST Name:*

Participant's Birthdate: MM/DD/YYYY*

Home Phone Number: (xxx) xxx-xxxx*

Cell Number: (xxx) xxx-xxxx

E-mail Address*

Parent 1 FIRST Name*

Parent 1 LAST Name*

Parent 2 FIRST Name

Parent 2 LAST Name

Address*

City*

State*

Zip*

Secondary E-mail Address: (optional)

I agree to let my child participate in soccer. I understand that there are certain risks of injury in the participation of this sport and I am willing to assume these risks. I confirm that my child is capable of participating in soccer and that he/she is in good physical condition. In addition to giving full consent to my child's participation, I waive, release and hold harmless Kiddie Soccer, it's officers, coaches and representatives for any injury that may be suffered by my child. I grant permission for my child to receive emergency medical treatment. I grant Kiddie Soccer permission to user photographic images of my child in it's promotional activities.

I agree

Promotional Code (Optional):

Region

Year

Season

Code	Location / Dates	Day/Time	Package Type	Action

Public Registration

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