Intramural Registration Form



PO Box 264


Bay Shore, NY 11706




Bay Shore Soccer Club Registration Form




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): ____________________________________________________




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