2026 Registration

NEW REGISTRATION

RETURNING PLAYER

First Name

Last Name

Team Name

Age Group: U-

DOB

Date

Age:

Phone Number

Area CodePhone Number

Emergency Contact/Phone #/Relation

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Gender:

Parent First Name Required if player is eighteen years old or younger

Parent Last Name Required if player is eighteen years old or younger

Parent Email/UserID Required if player is eighteen years or younger

Doctor to Notify

List any Medical Problems:

# of Seasons Played

Last Team

Date of Last Season

Other Children in Family Presently in League/Age

Jersey Size

Short Size

I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the BSYSA, it’s affiliated organizations and sponsors. Failure to comply will result in your departure from any event the league deems nescessary.

Recognizing the possibility of physical injury associated with soccer and in consideration for the BSYSA accepting the registrant for its soccer programs and activities. I hereby release, discharge and/or otherwise indemnify the BSYSA, its affiliated organizations and sponsors, their employees and associated personnel, including the registrant as a result of the registrant, participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. I further grant the BSYSA Parties the right Coach to use the player’s name, pictures and /or likeness in printed, broadcast and other material concerning the Programs provided such use is related to the player’s status as a participant in the Programs. Asst. Coach Team Manager Team Parent Special Projects Parent/Legal Guardian (please print) Field Preparation Board Member Signature: Date: PublicityDonor

Signature

Date

We ask for active participation of all parents in our program. Check area(s) in which you would be willing to help.

Parent Support

As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are Necessary to preserve the life, limb or well-being of my dependent.

Signature

Date

Email

example@example.com

Email

example@example.com

2026 Registration

Each child must have their own form completed. Separate payment required for each child. Payment must be made before submitting.

IMPORTANT

PARENTAL SUPPORT

CONSENT FOR MEDICAL TREATMENT (MINOR)

Registration Payment

Payment Methods

Enter coupon

2026 Registration

Each child must have their own form completed. Separate payment required for each child. Payment must be made before submitting.

IMPORTANT

PARENTAL SUPPORT

CONSENT FOR MEDICAL TREATMENT (MINOR)

Registration Payment*

Payment Methods

Registration Payment