Stateline Renegades
5U
Name of Athlete
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Information
Name of Emergency Contact
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation to Athlete
Walk out song
Allergies
This is a fill in the
T SHIRT SIZE
*
field. Please add appropriate fields and text.
Throughout the season, our team may choose to acknowledge or celebrate birthdays and holidays such as Easter, Mother’s Day, Father’s Day, Halloween, Thanksgiving, and Christmas. Please indicate if you are comfortable with your child participating.
Yes, my child may participate in all celebrations
No, I do not want my child to participate
My child may participate only in these celebrations:
Other
Submit
Should be Empty: