Brookland Jr High Soccer
coach Matt Modelevsky
bjhbearcatsoccer@gmail.com
High School Girls Coach
Kim Paslay
Jr High Soccer Tryout Registration
bjhbearcatsoccer@gmail.com
Student Name
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
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June
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December
Month
Please select a day
1
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Day
Please select a year
2025
2024
2023
2022
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2020
2019
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Year
Grade
Please Select
6th
7th
8th
9th
Homeschool but live in district
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
example@example.com
Phone Number
Secondary Phone Number
Guardian Name
Years you have played Soccer
Please Select
1-3 years
3-5 years
5+
None but excited to learn
Do you play Competitive (Travel) Soccer
Please Select
YES
NO
Not Currently, but have in the past
No travel soccer but play for City Stars
Jersey Size (Adult sizes)
Please Select
XS
S
M
L
XL
XXL
Requested Jersey Number (not guaranteed)
Additional Comments you want to share
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