MoCo Young Bucks
Date Today
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Month
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Day
Year
Date
Player Name
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First Name
Middle Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Information
Name of Emergency Contact (1)
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First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation to Athlete
*
Name of Emergency Contact (2)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation to Athlete
*
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Registration (Select One): Please send your payment to one of the payment options listed on the flyer.
Registration and Uniform Fee (covers all of registration and all of uniforms) $150
Summer Training (Fishing, firearm safety class, range time, football uniforms, and registration are all included) $250
Cash App/Venmo
If you're paying through Cash App or Venmo, please be sure to include the player's name in the notes section (e.g., 'For player Bob Jones') and take a screenshot of your payment for confirmation. Thank you!
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Signature
Date
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Month
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Year
Date
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