Page County Futsal Club Registration Form

Page County Futsal Club Registration Form

Please fill out the form below to register for the upcoming 2025-2026 futsal season. Please email pagecountyfutsalclub@gmail.com if you have any questions.
Athlete's First and Last Name

First NameLast Name
Birth Date

MonthDayYear
Date
Athlete's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Athlete's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current School Attending

Other
Athlete's Grade
Gender
Jersey/Shirt Size

Other
Parent/Guardian Name or Emergency Contact for Adults

First NameLast Name
Parent/Guardian Address or Emergency Contact for Adults

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number or Emergency Contact for Adults
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address or Emergency Contact for Adults
example@example.com
I and/or my athlete is interested in...
I agree to attend the Page County Futsal Club mandatory player/parent meeting on November 5th at 7:00 pm in the Page County Middle School auditorium
Signature for Agreement
Should be Empty: