Duchesne City Youth Sports Registration ApplicationStep 1Step 2Step 3Step 4Step 5Step 6Sport and Season SelectionPlease select the sport program and season your child is registering for.Sport- Select Sport -Youth SoccerT-Ball / Baseball / SoftballYouth BasketballFlag FootballVolleyballSeason & Year- Select Season -Spring 2025Summer 2025Fall 2025Winter 2025-2026Division / Age Group- Select Division -U4 (Co-ed)U6 (Co-ed)U8U10U12U14PreviousNextParticipant InformationEnter details for the child participating in the program.Participant First NameParticipant Last NameDate of BirthAgeGender- Select -MaleFemaleSchoolGrade Level- Select Grade -PreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeHome AddressStreet AddressAddress Line 2CityStateZIP CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePreviousNextParent / Legal Guardian InformationPrimary contact details for registration updates and emergency situations.Parent/Guardian NameRelationship to Participant- Select Relationship -MotherFatherLegal GuardianOtherPrimary Phone NumberPrimary Email AddressPreferred Contact Method Email Phone Call Text MessageShould another parent or guardian receive updates? Yes NoSecondary Parent/Guardian NameSecondary PhoneSecondary EmailPreviousNextMedical and Emergency InformationProvide medical details and emergency contacts to ensure participant safety.Emergency Contact Name (Non-Parent)RelationshipEmergency PhonePrimary Care PhysicianPhysician Phone NumberHealth Insurance ProviderPolicy NumberAllergiesMedicationsMedical Conditions / Physical Limitations Asthma Diabetes Seizures Heart Condition Physical Limitations Other medical conditionDescription of Medical Condition / AccommodationsAuthorized Pickup PersonsPreviousNextUniform and Team PreferencesSelect sizing and optional team placement requests.Shirt / Jersey Size- Select Size -Youth Extra Small (YXS)Youth Small (YS)Youth Medium (YM)Youth Large (YL)Adult Small (AS)Adult Medium (AM)Adult Large (AL)Adult Extra Large (AXL)Previous Experience Level- Select Experience -Beginner (First time playing)Intermediate (1-2 seasons)Advanced (3+ seasons)Preferred Team or CoachSibling or Teammate RequestAre you interested in volunteering as a Coach or Assistant Coach? Yes, Head Coach Yes, Assistant Coach No, thank youCoaching ExperiencePreviousNextWaivers, Permissions, and AgreementsPlease read and acknowledge the following terms to complete registration. I hereby certify that all information provided in this registration form is true, accurate, and complete to the best of my knowledge. I give permission for my child to participate in the registered Duchesne City Youth Sports program. In the event of injury or illness, I authorize Duchesne City recreation staff, coaches, and medical personnel to provide or secure emergency medical treatment for my child when necessary. I understand that youth sports involve risk of injury. I agree to assume all risks and release, waive, and hold harmless Duchesne City, its officers, employees, and volunteer coaches from any and all liability, claims, or actions arising out of participation. I agree to abide by the Duchesne City Recreation Code of Conduct. I acknowledge that registration fees are non-refundable once the season begins, and that registration placement is subject to availability. I understand that registration is not complete until payment is received separately by Duchesne City. Registration placement is subject to availability.Optional Permissions I grant permission to use photographs/videos of my child for promotional purposes. I consent to receive text-message notifications regarding schedules, updates, and weather alerts.Electronic Signature (Parent/Guardian)Signature DateSubmission Instructions Please review all information before submitting. No payment is collected inside this form. After submitting, please contact Duchesne City directly to arrange payment and finalize your child's registration. Previous Submit Form