Kentucky Youth Soccer Association Olympic Development Program
Secure Open Tryout Registration Form
The US Youth Soccer Olympic Development Program is a national program to identify and
develop youth players to represent their State, Region, and Country in soccer competition.
Registration Fee: $60.00 (pay by check or credit card)
It's Secure! KYSA uses Secure Socket Layer (SSL) technology to transmit your data to the server.

Required Fields are Marked with a "*"

Player Information
Player's Name* First Last
Birthdate* & Gender* mm dd yyyy   Boys Girls
Street Address*
City, State & Zip* ,   
Home Phone* ( ) -
Contact Email Address*
Confirm Email Address*
Playing Position* Goalkeeper Defender Midfield Striker
T-Shirt Size* YL Small Medium Large X-Large
Prior ODP Participation*
(in KY or other state)
Team/Coach Information
Club Affiliation*
Current Club Team*
Current Club Coach*
Coach's Home Phone ( ) -
Coach's Email Address
Medical Release*
CONSENT FOR MEDICAL TREATMENT MINOR
As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent.
Parent's Name*
Phone* ( ) -
Email
Payment Information
Method of Payment* Check  Credit Card (Mastercard or Visa)
Credit Card #
Credit Card Exp. Date /
Name on Card
Cardholder's Street Address
Cardholder's Zip Code
I/we (above indicated) hereby acknowledge that I/we have reviewed this form and caused it to be electronically executed with the intent to be bound to the terms contained herein*.

  

Please click ONLY ONCE on the Submit button above. 
Sometimes, it takes a few seconds for the form to be processed. Thank you.