Registration - Seneca, KS

Register you child in the City of Seneca’s Youth Soccer League! Games will be played on Saturday mornings beginning Sept. 7th.

If you have multiple children involved in summer recreation activities, you’ll need to submit a new registration form for each child. Download the informational flyer here!Youth Soccer Flyer

Summer 2013 Youth Recreation Registration Form

Participant's Name*
First Last
Date of Birth*
Month
Day
Year
Gender*
- Male
- Female
Age*
Current Grade*
Activity*
- Summer Baseball
- Summer Volleyball
- Summer Basketball
Registration Fee*
Family Payment Plan - $25.00 for the first child, $25.00 for the second child. Every child thereafter in the same family is free. ***Blast Ball/Tee Ball - $10 fee per participant, unless $50 max has been reached. Baseball, softball, blast ball, & tee ball are considered one activity. No refunds after the start date.
Parent / Legal Guardian Information
Parent / Legal Guardian # 1*
First Last
Phone*
Parent / Legal Guardian #2
First Last
Phone
Address*
Street Address City ZIP Code
Email*
Emergency Contact Information
Please list someone other than the Parent or Legal Guardian.
Name*
First Last
Phone*
Relationship to participant
List any medical conditions
Volunteer Coach
Select the following if interested in coaching.
Name
First Last
Position
- Head Coach
- Assistant Coach
Waiver Release Statement
As a parent or legal guardian of a participant of this program, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of my child's injuries, including loss of life, damages or loss which he/she may sustain as a result of participation in any and all activities connected with or associated with such program. I further agree to, on behalf of my child, waive and relinquish all claims, full release and discharge and agree to indemnify and hold harmless and defend the City of Seneca and its officers, agents, servants, and employees including coaches umpires, and referees from any and all claims resulting from injuries, including loss of life, damages, and losses sustained by my child arising out of, connect with, or in any way associated with the activities of the program.
I, the Parent/Legal Guardian of the above named participant have read and understand the Waiver Release Statement. I agree to abide by all policies and guidelines set forth by the City of Seneca regarding this program.*
First Last
Date*
MM slash DD slash YYYY
Total
$0.00

Summer 2013 Youth Recreation Registration Form

Parent / Legal Guardian Information

Emergency Contact Information

Volunteer Coach

Waiver Release Statement

Service Updates