Intramural Registration Form



 

 

PO Box 264

 

Bay Shore, NY 11706

 

bayshoresoccer@hotmail.com

 

www.bayshoresoccer.org

 

 

 

Bay Shore Soccer Club Registration Form

 

Spring__________Fall__________

 

Micro 2-3____ Grasshoppers 4-5____ Kangaroo 6-7____ Knee high 8-9____ Midgets 10-13____ Play up____

 

 

 

Child’s Age:__________ Child’s Date of Birth:___/___/____ Child’s Sex:___________

 

Child’s Name (Last, First): ____________________________________________________

 

Address:__________________________________________________________________

 

City: __________________________ State: _______ Zip: ____________________

 

Parent(s)/Guardian(s) Name (Last, First): ________________________________________

 

Phone: (Home) ____________________________ (Cell) ___________________________

 

Please check box if you wish to authorize text messages from the Bay Shore Soccer Club:

 

Email Address: _____________________________________________________________

 

Please note any special condition you feel either the Club or your child’s coach should be made aware of:

 

 

 

_____________________________________________________________________________________

 

 

 

Registration Fee: First Child: $135; Second Child: $130; Third Child: $125; Late fee $25

 

Registration fee $____________

 

Additional fees $____________

 

Total price $____________

 

Payment Method: Cash______Check_______Check number_______

 

The Bay Shore Soccer Club welcomes volunteers! Please check any areas of interest:

 

Coach ______ Assistant Coach ______ Team Parent _______

 

Parent’s Declaration

 

 

 

In registering my child, I understand that, as parent or guardian, I am obligated to perform certain tasks or duties as may be assigned by the Executive Board consistent with the operational needs of the Club, such as ensuring that my child is wearing the proper uniform, cleats and shin guards for all games and practices. Failure to show reasonable effort to perform these duties will result in the termination of this registration with forfeiture of all fees paid. Parents, once completed, please make a copy of this form for your records.

 

 

 

Parent or Guardian Signature _________________________________________________

 

 

 

BSYSC Form dated 12/29/19

Travel Registration Form

Game Change Request

Add/Delete Player

Parent Signature