Under 19 Registration Form

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Date of Birth: (dd/mm/yyy): *
First Name: *
Last Name: *
Fathers Name: *
Mothers Name: *
Email Address: *
Address: *
City: *
Zip Code: *
Gender:
Phone: *
Date: (dd/mm/yyy): *
	I / we certify that the information contained on this form is accurate and true. I recognize that soccer has ingerent risks. I certify that my child is fit to play the sport. I / we waive and release and will indemnify the St. Clair Shores Youth Soccer Leage (SCSYSL), its coaches, referees, board members and volunteers from any and all claims and expenses of any kind as a condition of child's registration. My child and I agree to abide by the rules of SCSYSL. I give consent for emergency medical care to be rendered to my child. This care may be given under whatever conditions are necessary to preserve the life, limb and well being of my child.

Parent Name Submitting Online Form: *
Security Code: *

St. Clair Shores Youth Soccer League

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U19 Registration

This registration is for the U-19 Spring 2012 Season ONLY.

To play in this division, you cannot turn 19 before 8/1/12. If you have not played in SCSYSL before you will need to supply a copy of your birth certificate.

Online Registration Fees are as follows: Under 19 - $68. Registration must be paid in FULL to be accepted. *These registration fees include a $3.00 service fee to pay by credit card.

Refund Policy: There will be a $10.00 administrative fee for all refunds that were registered online requested before August 1, 2011