East Stroudsburg FC
PO Box 617
2008 Late Fall  Registration Form           

     Age Division U    Check Number  Cash

Male            Female    Possible Travel Player Yes No
Eastern Pennsylvania Youth Soccer Association Participant Registration Form
East Stroudsburg Junior Soccer League
New Player            Returning Player            Coach  

Last Name First Name

Address   City     State   Zip     

Telephone   Email Address     Birth Date 

Age     Birth Date     Grade

Name of School   Resica Elementary J.T. Lambert Imtermediate Lehman Intermediate J.M. Hill Elementary Middle Smithfield Smithfield Elementary East Stroudsburg Elementary Bushkill Elementary Notre Dame Other      Parent/Guardian Name  

Uniform Size   Shirt   YS YM YL AS AM AL               

Release Statement
Note: The Statement should be signed by parent/guardian for minor player; an adult player for himself;coach for himself;and administrator for himself.
I, the parent/guardian of the registrant, a minor, or adult registrant of legal age, agree that I and the registrant will abide by the rules of the EPYSA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with socer and in consideration for the EPYSa accepting the registrant for its soccer programs and activities (the "Programs"), I hereby release, discharge and /or otherwise indemnify the EPYSA, its affliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs, and/or being transported to or from the same, which transportation I hereby authorize.

Parent/Guardian/Adult Signature_______________________ __      Date __________

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