Player Contact Information
First name
Last name
Gender
Male
Female
Birthday
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
E-mail address
Phone
Address
City
Zip
Parent/Guardian #1 Contact Information
Copy address details from above
First name
Last name
E-mail address
Phone
Address
City
Zip
Relationship to player
--select one--
Mother
Father
Grandmother
Grandfather
Guardian
Other
Interested in coaching
No
Yes - Head Coach
Yes - Asst. Coach
Parent/Guardian #2 Contact Information
Copy address details from above
First name
Last name
E-mail address
Phone
Address
City
Zip
Relationship to player
--select one--
Mother
Father
Grandmother
Grandfather
Guardian
Other
Interested in coaching
No
Yes - Head Coach
Yes - Asst. Coach
Emergency Contact Information
Contact
Contact Phone Number
Relationship to player
Medical Comments
Comments
Uniform Information
Uniforms are NON-RETURNABLE. Please be sure to choose the appropriate size for your player, paying special attention to the youth and adult designations.
Jersey Size
--select one--
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Payment options
$35 (full payment) via credit card today
$35 (full payment) via check (must be rec'd within 5 business days)
If paying by check please send your payment along with the player name/parent name and confirmation number with your check to the address below.
First name on credit card
Last name on credit card
Credit card number
Credit card expiration (0415)
Credit card CCV
Billing Address
Billing City
Billing State
Billing Zip
Mail fees and correspondence to:
Gates Youth Soccer League (GYSL)
2117 Buffalo Rd
PO Box 191
Rochester, NY 14624