UAA Participant Registration Form

Participant Registration Form

Ummah Athletics Association (UAA)
Player Name

First NameLast Name
Player Birth Date*

MonthDayYear
Player Gender
Desired Sports/Fitness Program*

UAA Mini Clinic SoccerUAA Go Sports & Fitness
T-shirt Size

Youth X-SmallYouth SmallYouth MediumYouth LargeYouth X-LargeYouth XX-LargeAdult SAdult M
Parent Contact Name

First NameLast Name
Parent Contact Phone*
Parent Contact E-mail*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Conditions / Allergies:
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Player
Parental Consent - I give permission for my child to participate in the Ummah Athletics programs. I understand that volunteers are supervising and that reasonable precautions will be taken to ensure safety. In the event of an emergency, I authorize medical treatment if I cannot be reached.

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