Youth soccer registration

Athlete Info

Athlete Name:*
Date of Birth:*
Current Grade In School*
Current School:*
Home Address:*

Parent Info

Parent Name:*
Home Phone:*
Cell Phone:
Place of Employment:*
By checking the box below, the parent listed, being legal guardian of the athlete, hereby grants permission for the named applicant to participate in this program with the understanding that Ken-Rock Community Center, their officers, agents, or employees are not responsible for injuries which may occur. By checking this box said guardian accepts that he/she is aware of the risk and hazards inherent in participating in this event and with such knowledge, consents to the applicant, named above, to participate.*

**Note there are NO REFUNDS after the first practice**

VOLUNTEER COACHES ARE NEEDED! Please consider coaching a team. If you successfully complete the season your child's fee will be refunded. Fill in your name if you can coach your child's team:
Special request or coach's name:
Select Product:


Be Involved

Ken-Rock Community Center is renowned for its youth recreation sports programs. Over 1,200 boys and girls participate in year round sports and recreational activities. Fun, Sportsmanship and skill development is the focus of these programs along with a stress on character development.

All of Ken-Rock's sports programs depend on volunteers. If you are interested in volunteering contact Athletic Director Ron Adams by email at or by phone at (815) 398-8864.

Get in Touch