Tillie's Touch - Soccer Recreation Program Registration

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Tillie's Touch - Soccer Recreation Program Registration - March/April 2026

Event Timing: 5 Week Session: Friday's : 03/27/26, 04/03/26, 04/10/26, 04/17/26, & 04/24/26

At Tillie’s Touch: 211 Catawba St, Syracuse, NY 13208

* An adult must be present for the entire session each week.

Email *

Untitled Title

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 *

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 *

Male

Female

Other:

Race/Ethnicity *

Asian/Bangladeshi

Asian/Burmese

Asian/Chinese

Asian/Filipino

Asian/Indian

Asian/Korean

Asian/Japanese

Asian/Nepalese

Asian/Pakistani

Asian/Vietnamese

Asian/Other

Pacific Islander/Guamanian and Chamorro

Pacific Islander/Native Hawaiian

Pacific Islander/Samoan

Pacific Islander/Other

White

Black or African American

Hispanic or Latino

American Indian or Alaskan Native

Two or more Races

Other (Middle Eastern & North African)

Other:

Primary language spoken in the home *

English

Arabic

Bengali

Chinese

French

Haitian Creole

Italian

Korean

Polish

Russian

Spanish

Urdu

Other (Kinyarwan)

Other (Swahili)

Other (Tigray)

Other (Rohingya)

Other (Bosnian)

Other (Dari)

Other (Somali)

Other:

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.

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