Tillie's Touch - 2nd / 3rd grade Soccer Bookworm Program Registration                January/Feburary 2026 session 
Event Timing: 5 Week Session: Saturday's  1/17/26, 1/24/26, 1/31/26, 2/7/26, 2/14/26
2nd & 3rd grade:  10:00 - 11:00am
At Tillie’s Touch: 211 Catawba St, Syracuse, NY 13208
Contact us at: Dale Johnson; (315) 254-8569; tilliestouchsyr@gmail.com with any questions.
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Email *
Register your child to play in the Tillies Touch Recreational Soccer Program.  Please only register your child if they plan to attend.  We have a limited number of spaces for indoor sessions.
Childs Full Name (first and last) *
Childs Birthdate *
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DD
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Childs Street address number (i.e 211) *
Childs Street name (i.e. Catabwa St.) *
City Child lives in (i.e. Syracuse) *
Childs home zipcode *
Gender *
Race/Ethnicity *
Primary language spoken in the home *
School Child Attends *
Childs Grade *
Childs Age *
Parent / Guardian's full name *
Phone number of Parent/Guardian *
Email
Does your child have any medical needs that are important for us to know? *
I/We, the parents of the above name candidate, hereby give me/our approval to their participation in any league, non league, soccer clinic activities. I/We assume all risks and hazards incidental to such participation including transportation to and from activities. I/We do hereby waive release, absolve, indemnify and agree to hold harmless this organization, the organizers, directors, coaches, volunteers, sponsors, supervisors, participants, and persons transporting my/our child to or from activities, for any claim arising out of an injury to my/our child whether the result of negligence or for any other cause, except to the extent and including the amount covered by accident or liability insurance.  I also give permission for my child to be photographed with the possibility of use for Tillie's Touch social media / marketing.

Please type your name and the date below if you agree.
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