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Maple Leaf Farms

Spring 2021 Youth Individual Registration

* Required Fields
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Fee: $85.00Registration cost is $85.00 per player this year. This covers the player's participation for 12 game/practice sessions and team jersey. Standard registration will be open through Sunday, March 7th. A late fee will be assessed for registrations received after March 7th and registrations will be CLOSED when league divisions are full.
KCSL Soccer will attempt to include players born in the calendar years 2005 through 2016  (16 and Under through 5 years old).  See the USYS Age Matrix in the Downloads section of this site for clarification and refer to the 2020-2021 Season column.  We reserve the right to cancel age divisions that are not full.
Player Information
*How many years have you played in soccer leagues?
*Please rank your player's skill level from 1-5:
1 - Novice -  Possibly the player's first time playing organized soccer. It may be still unclear if they enjoy the game. They play because their friends do or because their parents want them to try it.
2 - Beginner - The player is still learning the game but seems to be enjoying it.
3 - Intermediate - The player enjoys playing the game and is also showing the potential to excel at athletics.
4 - Proficient - Not the top player on every team, but close to the top. The player is athletic enough to compete with other top players.
5 - Advanced -  The top player on most teams or the most athletic player on the team.
*Player First Name
*Player Last Name
*Street Address
*Zip Code
*Gender (IMPORTANT! Please confirm this is correct)
*Player's Date of Birth (Indicate YEAR of birth)
*Current Age
*Jersey Size (IMPORTANT! Please confirm accuracy)
Don't type in this field
For assistance with jersey sizes, Please click here for a sizing chart.
Approx. Height (used for uniform information)
Approx. Weight (used for uniform information)
Medical Conditions/Allergies
Special Player Needs or Requests
No special team requests can be guaranteed with the exception of siblings in the same age-appropriate division.
Parent or Guardian 1 Information
*Parent/Guardian 1 First Name
*Parent/Guardian 1 Last Name
Street Address (if different from above)
Zip Code
*Primary Contact Phone Number
*Is this a mobile phone number?
*Parent/Guardian Email Address
*Would you help as a team Coach or Asst Coach?
Coaching Experience
Parent or Guardian 2 Information
Parent/Guardian 2 First Name
Parent/Guardian 2 Last Name
Street Address (if different from above)
Zip Code
Contact Phone Number
Is this a mobile phone number?
Parent/Guardian 2 Email
Would you help as a team Coach or Asst Coach?
Coaching Experience
Alternate Emergency Contact Information
*Emergency Non-Parent Contact Name
*Emergency Non-Parent Contact Phone Number

Insurance Disclaimer and Medical Release:  I/We the parents/guardians of the child named on this form, who is a  candidate for a position on a team in the Kosciusko County Soccer League, hereby give my/our approval for my/our child’s participation in any and all KCSL activities.  I/We assume all risks and hazards incidental to such participation including transportation to and from the activities; and I/We do hereby waive, release, absolve, indemnify and agree to hold harmless the Kosciusko County Soccer League, CCAC, organizers, directors and/or officers of the executive committee, advisory board, sponsors, supervisors, participants and persons transporting my/our child to and from activities, from any claim arising from any injury to my child.

I hereby give the Kosciusko County Soccer League and it's representatives permission to seek and provide emergency medical attention for the child named on this form should it become necessary due to his/her participation in the league.

Code of Conduct: My player and I agree to abide by the KCSL Code of Conduct and Parent-Player Commitment which is available to me to download on this site and at the CCAC during the season.

*Waiver confirmation
 I have read and agree with the Insurance Disclaimer/Medical Release and Player-Parent Code of Conduct. 
Refund Policy:  No refunds are issued.  Once payment is received fees are expended and commitments to vendors are processed.  The only exception to this is if we are required to cancel the age division of your player(s).
*Refund confirmation
 I have read and understand the Refund Policy. 
Non-Payment Policy:  Players WILL NOT be placed on a team without receiving payment.  A registration alone is NOT considered complete.
*Non-payment Policy confirmation
 I have read and understand the Non-payment Policy. 
PayPal payments DO NOT require you to have a PayPal account.  Simply select Pay with Debit/Credit Card option.
Total Due:
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