Tillie's Touch - 5th / 6th grade Soccer Recreation Program Registration - January/Feburary 2026
Event Timing: 5 Week Session: Friday's  1/16/26, 1/23/26, 1/30/26, 2/6/26, 2/13/26
5th/6th grade boys/girls:  7:00pm-8:30pm
At Tillie’s Touch: 211 Catawba St, Syracuse, NY 13208
Contact us at: Dale Johnson; (315) 254-8569; tilliestouchsyr@gmail.com with any questions.
Sign in to Google to save your progress. Learn more
Email *
Register your child to play in the Tillie's 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 *
MM
/
DD
/
YYYY
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 *
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.
 *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms