REIGN FC SELECT REGISTRATION
SPRING 2022 SEASON
PLAYER
First Name
Last Name
PLAYER DATE OF BIRTH
-
Month
-
Day
Year
Date
PLAYERS GENDER
Male
Female
PLAYER ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SCHOOL ATTENDING
blanks
PARENT/GUARDIAN NAME
First Name
Last Name
PARENT/GUARDIAN CELL PHONE NUMBER
Please enter a valid phone number.
PARENT/GUARDIAN EMAIL ADDRESS
example@example.com
PARENT/GUARDIAN #2 NAME
First Name
Last Name
PARENT/GUARDIAN #2 CELL PHONE NUMBER
Please enter a valid phone number.
PARENT/GUARDIAN #2 EMAIL ADDRESS
example@example.com
PRIMARY EMERGENCY CONTACT
First Name
Last Name
RELATIONSHIP TO PLAYER
blanks
PRIMARY EMERGENCY CONTACT CELL PHONE NUMBER
Please enter a valid phone number.
Describe any allergies that we need to be made aware of.
Describe any medical conditions that we need to be made aware of.
UNIFORM SIZE
youth small
youth medium
youth large
Submit
Should be Empty: