Player Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Legal Guardian Name *

First Name

Last Name

Parent/Legal Guardian Phone *

(###)

###

####

Parent volunteers are essential to making this league work. Can you volunteer to coach a team?

Yes

No

I give Hampton Bays Youth Soccer Corp. permission to photograph and/or video for media purposes. *

YES, I give my permission

NO, I do not give my permission

Date *

MM

DD

YYYY

Digital Signature *

By clicking this button I acknowledge that I am the Parent/Legal Guardian of the above named child and give permission for them to participate in Hampton Bays Youth Soccer activities and events. I also understand that clicking the "SUBMIT" button below acts as my digital signature.