Rec Soccer Registration DUE August 18th 2025 $30Contact InformationChild's First Name (required)Child's Last Name (required)Street Address (required)City (required)Child's Birthday (required)Age (required)34567891011School Grade (required)Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeGender (required)MaleFemaleGuardian #1 Name (required)Guardian #1 Phone Number (required)Email Address (required)Guardian #2 Name (if does not apply put N/A) (required)Guardian #2 Phone Number (if does not apply put N/A) (required)Email AddressSkill Level (required)BeginnerModerateExperiencedTravelT-Shirt SizeT-shirt Sizes (required)Youth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-LargeList any Medical Problems/Allergies (required)I, the undersigned parent of ____________________________(Player’s name) recognize the possibility of physical injury associated with soccer, hereby release the Worland Recreation District, its officers, league coaches, organizers, referees and all associated personnel against ANY claim by or for the registrant as a result of the registrant’s participation in the program. As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.Your Signature (required)Confirm e-SignatureReview Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signaturesCOACHES NEEDED. Volunteer coaches required. If you are willing to coach please indicate below. If you are selected as a coach your registration fee will be refunded. If we don’t have enough coaches that means more players per team and less playing time. Only your own child may be requested for your team. (required)YesNoPay Now
