Acushnet Youth Soccer

Registration for Youth Soccer

2022 Fall Season

Ages U6 - U15

Co-ed Instructional and Competitive

Cost: $125 per player (includes processing fee)

* Note: All fields required!

Player Information

Player First Name:

Last Name:

Date of Birth:

Gender:

Grade (during season):

Address:

City:

State:

Zip Code:

Phone:

Parent/Guardian Information

Parent/Guardian #1

Name:

Phone:

Email:

Parent/Guardian #2

Name:

Phone:

Email:

Medical Information

Conditions:

Physician:

Physician Phone:

Emergency Contact:

Emergency Contact Phone:

Uniform Sizes

Jersey:

Shorts:

Socks:

Misc.

Please select 'Yes' if you are new to the Fall program:

Please select 'Yes' if you allow us to potentially use your child's picture on the league's social media webpages:

Parental Approval and Medical Release

Recognizing the possibility of physical injury associated with soccer in consideration for Mass Youth Soccer accepting my child to the Acushnet Youth Soccer, I hereby release, discharge and/or otherwise indemnify Mass Youth Soccer, its affiliated organizations, including, but not by way of limitation, the fields and facilities used for Acushnet Youth Soccer, against any claim by me or on my behalf of my child as a result of my child's participation at Acushnet Youth Soccer and or being transported to or from any practice or competition associated with the Acushnet Youth Soccer which transportation I hereby authorize. My child has received a physical examination by a physician and has been found physically capable of participating in soccer. I hereby give my consent to have an athletic trainer, emergency medical technician and/or Doctor of Medicine or dentistry provide my child with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of such assistance and/or treatment.

Name of Parent/Guardian:

Today's Date:

Birth Certificate Upload

If possible, please upload a picture of the player's birth certificate for age group verification.

Payment

Acushnet Youth Soccer

Registration for Youth Soccer

2022 Fall Season

Ages U6 - U15

Co-ed Instructional and Competitive

Cost: $125 per player (includes processing fee)

Please fill out the form in its entirety in order to access payment.