Player Registration Form

Player Registration Form
Name of Child*
First NameLast Name
School Name*
Grade*
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Date of Birth*
MonthDayYear
Date
Age*
Parent/Guardian*
First NameLast Name
Daytime Telephone*
Please enter a valid phone number.
Parent/Guardian
First NameLast Name
Daytime Telephone
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact*
First NameLast Name
Cell Phone*
Please enter a valid phone number.
Relationship to Player*
If other please specify. If it does not apply, please put N/A*
Accident Medical Coverage is second to any other collectible insurance; Primary, if no other insurance is force.*
I/We agree with aboveI/We disagree with above
Signature*
Clear