Sign Up

FIND A PLAYER
FIELDS
LAWS OF THE GAME
CODE OF CONDUCT

Online Registration
CHOOSE YOUR METHOD TO REGISTER
Payment Due within 10 days of online signup

First Name

Last Name

Sex*

Male

Female

Date of Birth

Grade

Social Security Number
needed for medical & registration
- -

Shirt Size

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Email Address — where coaches & administrators can contact you

Father’s Name	Work Phone
Mother’s Name	Work Phone

Any previous soccer experience?
Yes
No

If yes, what was the name of your last team?

If yes, what was the name of your last coach?

Insurance Company Insurance Number	Doctor Doctor Phone
Emergency Contact	Emergency Phone
Please describe any health concerns.

Parents - Check positions you will help with
Head Coach	Field Maintenance	Snack Stand
Assistant Coach	Equipment
Referee	Age Group Coordinator

Release:
I, the parent or legal guardian of the registrant, a minor, or adult of legal age, agree that I and the registrant will abide by the rules of the Ephrata Youth Soccer Club, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration of EYSC accepting the registrant for its soccer program and activities, I hereby release, discharge and/or otherwise indemnify EYSC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields, and facilities utilized by the EYSC, against any claim by or on behalf of the registrant as a result of the registrant's participation in the EYSC, and/or being transported to or form the same, which transportation I hereby authorize.
In the event of my absence, the above-named player may be admitted to any hospital or medical facility for dialogistic and treatment. I request and authorize physicians, dentist, and staff, duly licensed as Doctors of Medicine, or Doctors of Dentistry or such licensed technicians or nurses to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee of the results examination or treatment. I authorize the hospital or medical facility to dispose of specimens or tissue taken from the above named player.

Team rosters (Name Only) will be listed on our web site.
Check for your child's name to be listed in the team roster.
NOT listed in the team roster.

...do it the
“old fashioned” way

Click to download a registration form in PDF.
Print it out.
Fill it out.
Mail it out to EYSC.

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REGISTRATION FEES

Registration Fees if Received by
7/1/2008
if Received after
7/1/2008
(add $20 late fee)

Intramural/Rec
Birthdate before
8/1/2000 - $65

Birthdate between
8/1/2000 and 7/31/2002 - $50

Birthdate on or after
8/1/2002 - $40

Under 10 Advanced Intramural
Birthdate between
8/1/1998 and 7/31/1999 - $65