KYSA-form

FEE: $80.00 Payable to KYSC. Supplied new uniform will be jersey, shorts & socks. You will need to purchase shin guards, soccer cleats & soccer ball.

Child's Name

Date of Birth

mm/dd/yy

Boy or Girl?

Second Child's Name

Date of Birth

Boy or Girl?

Third Child's Name

Date of Birth

Boy or Girl?

Address (include city & zip)

Email

Confirm

Parents Names

On all phone numbers below, numbers only, no dashes

Home Phone

Work Phone

Cell Phone

Last Season Team or If you want to change teams please indicate new team

Uniform Size 1st Child

Uniform Size 2nd Child

Uniform Size 3rd Child

Comments

Payment Amount

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