ESYN INDOOR SOCCER 2026 Registration Form

ESYN INDOOR SOCCER 2026 Registration Form

Register for the ESYN Indoor Soccer 2026 season. Please provide participant, parent/guardian, and emergency contact details below.
Participant Information

Please enter the participant's details.
Name

First NameLast Name
Gender

MF
Date of Birth

MonthDayYear
Date
Age
Grade
School
Accommodations Needed
Insurance Company
Policy #
Siblings placement note

YesNo
Primary Parent/Guardian Information

Please provide the primary parent or guardian's contact information.
Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
State
Zip Code
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Text message permission

YesNo
Email
example@example.com
Emergency Contact Information

Provide an additional contact in case of emergency.
Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Zip Code
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
I realize that no medical insurance is provided by the Central Valley Resource Center and Exceptional Sports for Youth with Needs and agree to assume the risk for any injury related to my participation or the participation of my dependent. So I agree to make no claims against the Central Valley Resource Center and ESYN or any of its officers, employees, or volunteers for any injury arising from this activity, however caused including liability for negligence. My dependent is physically able to participate in the activity. I consent to any medical treatment my dependent needs while” involved in this activity and I agree to pay for it. I understand that my child’s picture might be taken as a part of this program to promote our program on fliers, brochures, organization website and marketing pamphlets. If this box is marked, I authorize release of my child’s name and address to other community service groups for the purpose of promotion for their programs.

Authorization to Release
Should be Empty:

ESYN INDOOR SOCCER 2026 Registration Form

Participant Information

Primary Parent/Guardian Information

Emergency Contact Information