Congratulations on your child's invitation to play for Nationals during the 2021/22 soccer year.
PARENT/GUARDIAN SIGNATURE. Signing below indicates that you accept the terms and conditions listed above.
*
Players First Name
*
Please do not use your browser autofill for the name.
Players Last Name
*
Please do not use your browser autofill for the name.
Club Name
Nationals
Location
*
Capital Area
Genesee
Girls Academy
Lapeer Select
Livonia
Macomb
Macomb Select
Oakland
St. Clair
Troy
Union
Team Birth Year
*
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Select the BIRTH YEAR of the TEAM you are playing on.
Team Gender
*
Boys
Girls
Select the GENDER of the TEAM you are playing on.
Team Color
*
Black
Red
White
Blue
Enter the team color assigned to you by the coach.
Player Gender
*
Female
Male
Select PLAYER gender.
Player Date of Birth
*
-
Month
-
Day
Year
Date
New or Returning Player
*
New
Returning
NEW indicates you play at any Nationals location this past year; RETURNING indicates you played this past season at ANY Nationals location.
Player Jersey Number #1 Choice
*
Player Jersey Number #2 Choice
*
Player Jersey Number #3 Choice
*
Player Jersey Number #4 Choice
*
Player Street Address
*
Example: 12345 Anywhere Road
Player City
*
Player State
*
MI
Canada
Player Zip
*
Parent/Guardian 1 First Name
*
PARENT/GUARDIAN FIRST name - do not use autofill from your browser to completion this field.
Parent/Guardian 1 Last Name
*
PARENT/GUARDIAN LAST name - do not use autofill from your browser to completion this field.
Parent/Guardian 1 Email
*
MUST be in email format
Parent/Guardian 1 Mobile
*
Parent/Guardian 2 First Name
OPTIONAL ENTRY - PARENT/GUARDIAN FIRST name - do not use autofill from your browser to completion this field.
Parent/Guardian 2 Last Name
OPTIONAL ENTRY - PARENT/GUARDIAN LAST name - do not use autofill from your browser to completion this field.
Parent/Guardian 2 Email
OPTIONAL ENTRY - MUST be in email format
Parent/Guardian 2 Mobile
Player Medical Issues
*
Type NA or None if PLAYER does not have any medical issues
Player Allergies (list any issues or type NA)
*
Type NA or None if PLAYER does not have any allergies
Physician Name
*
PLAYER Physician Name
Physician Phone
*
Submit
Should be Empty: