Fall Soccer Youth Registration Form

Athlete Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearAges 2007-2022
Age
Age based on date of birth
Proof of Age (required for 8U-14U)

Richmond Parks and Recreation accepts: a picture of a DMV ID card, or school ID card.
Cancelof
School Name
Jersey size
Youth XS (4-5), Youth S(6-8), Youth M(9-10), Youth L(11-12).
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Name

First NameLast Name
Relationship to Participant
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
I would like to volunteer to help Ansars
Additional details or ways I would like to contribute this season

I, {parentguardianName}, the undersigned parent/guardian, hereby grant permission for my child, {athleteName}, to participate in Team Ansars Recreation youth soccer programs and activities. I understand that participation in soccer involves certain risks, and I hereby release and hold harmless Team Ansars, its officers, employees, and agents from any and all liability for injuries or damages that may occur.

I agree to conduct myself in accordance with Team Ansars’ Parent and Guardian Conduct Policy, and I agree to ensure that the athlete conducts themselves in accordance with Team Ansars’ Player Conduct Policy.
Parent/Guardian Consent
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

I, {name16}, grant permission for photographs, videos, and/or other media recordings of my child, {athleteName}, to be used for promotional purposes related to the Team Ansars Recreation youth soccer program.
Parent/Guardian Consent
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Authorized Guardian’s Name

First NameLast Name
Relationship to child
Authorized Guardian’s Phone
Please enter a valid phone number.Format: (000) 000-0000.
I, {name16}, hereby authorize the above-named individual to pick up my child, {athleteName}, from Team Ansars activities/events. I understand that the authorized individual will have to provide photo ID at pick up, that this authorization is valid until further notice and can be revoked by me at any time in writing.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Fall Soccer Registration

This fee covers: league fees, field rentals, refreshments

$90.00

Enter coupon

Total

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Donate to Team Ansars

Every contribution, no matter the amount, makes a difference. Thank you for supporting our players and our community!
Donate Here!

Ansars Family and Youth Services, Inc. is a 501(c3) organization committed to providing a fun, competitive, and faith-centered soccer experience for youth in the Richmond area. While registration fees help fund the program, they don't fully cover the entire costs of the soccer season.

If you're in a position to do so, please consider making an optional donation. Your support helps us keep our program accessible and continue investing in the community's next generation of athletes and leaders.

Every dollar goes back into supporting our youth and strengthening our community. Thank you for your generosity!
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Donate to Team Ansars