EYSC exists to promote quality Youth Soccer to the surrounding Ephrata, PA area.

EYSC Player Registration

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EYSC Player Registration
Online Registration
CHOOSE YOUR METHOD TO REGISTER
Payment Due within 10 days of online signup
Register Online with this form, or... The old fashion way... On the right.

First Name *
  Last Name *
  Sex *
Male    Female

School Name
  Grade

Date of Birth *
  Shirt Size
  Short Size
 
Address Line 1 *

Address Line 2

City *

  State *
  Zip Code *
 
Primary Contact Info: (where Coaches & Admins contact you) *
Primary Phone*
xxx-xxx-xxxx
  Primary Email*
 
Parent 1 Info:
Father’s Name (Parent 1)
  Father Cell Phone (Parent 1)
xxx-xxx-xxxx
Father’s Email (Parent 1)
 
Parent 2 Info:
Mother’s Name (Parent 2)
  Mother Cell Phone (Parent 2)
xxx-xxx-xxxx
Mother’s Email (Parent 2)

Any previous soccer
experience?
Yes
No
  What Club
EYSC
Other
 # Of Years
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 Name

Doctor Phone
xxx-xxx-xxxx
Emergency Contact
  Emergency Phone
xxx-xxx-xxxx

Health Concerns - Please describe any health concerns

Father (Parent 1) - Check positions you will help with
Head Coach Field Maintenance   Tournament Volunteer   Fundraising
Assistant Coach   Equipment Team Helper Age Group Coord.
Referee

Mother (Parent 2) - Check positions you will help with
Head Coach Field Maintenance   Tournament Volunteer   Fundraising
Assistant Coach   Equipment Team Helper Age Group Coord.
Referee
 
Special Requests - including practice nights not available
 

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. EYSC also reserves the right to take photos of individual players & teams that may be used on the EYSC website and other promotional material to help promote the Ephrata Youth Soccer Club. By registering your player you give consent to EYSC for their image to be used in this manner.

In the event of my absence, the above-named player may be admitted to any hospital or medical facility for diagnostic 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.

Visibility * - 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.

      Only hit submit ONCE, then wait for process to complete!

Fall 2014
Registration Info:
Deadlines:
• Rec: June 30, 2014

Registration Form:
2014 Registration Form

CLICK HERE

Registration Fee Info:
Intramural/Rec Birthdate:

before 7/31/02 – $85
between 8/1/02 and 7/31/06 – $75
between 8/1/06 and 7/31/08 – $65
on or after 8/1/08 – $55