Player Registration Form
Name of Child
*
First Name
Last Name
School Name
*
Grade
*
Please Select
2
3
4
5
6
7
8
9
10
11
12
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
/
Month
/
Day
Year
Date
Parent/Guardian
*
First Name
Last Name
Daytime Telephone
*
Please enter a valid phone number.
Parent/Guardian
First Name
Last Name
Daytime Telephone
Please enter a valid phone number.
Email
*
example@example.com
Shirt Size
Emergency Contact
*
First Name
Last Name
Cell Phone
*
Please enter a valid phone number.
Relationship to Player
*
Please Select
Parent/Guardian
Grandparent
Aunt/Uncle
Sibling
Other
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 above
I/We disagree with above
Signature
*
Back
Next
Signature of Player
*
Signature of Parent
*
Date
*
-
Month
-
Day
Year
Date
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: