Soccer Registration Form

Please fill out the following information.  PLEASE NOTE: Your registration is not complete until the registration fee is paid for each child.  The fee is $65.00 per child (Late registration August 30th will be $80.00) plus a 3% charge for PayPal and includes the Team Shirt, shorts, and socks. Parent's have the option of purchasing a t-shirt to support their child's team for $15.00.  Follow the instructions to pay by check or credit card after you submit your registration.

If you have more than one child to register, you will need to fill out this form for each child.  After submitting the first registration, there will be a link to begin a new form.

By filling out this form:

You, the parent/legal guardian, affirm that you have read the General Information Sheet, and you have read, agree with and agree to abide by Yazoo Christian Soccer Club Parent's Code of Ethics and the Wardell Leach Recreation Complex Rules.

If you have any questions please email

Child's Name Required

Child's Gender Required

Child's birthdate (month, day, year) Required

Team played on last season (if applicable)

Parent or Legal Guardian Required

Address Required

Primary Telephone # Required

Secondary Telephone #

Email Address Required

Emergency Contact (other than above) Required

Emergeny Contact Telephone # Required

Child's Jersey Size Required

Child's Short Size

Child's Sock Size (shoe size)

Would you be interested in coaching?

# of Parent Team Shirts Desired (optional, $15 each)

Sizes (i.e.: 1M, 1XL)

Child's age as of Sept. 1, 2017 Required