Kick it for Kwirkz Registration

Kick it for Kwirkz Registration

Register as a participant or volunteer for the adaptive soccer event on June 28, 2026, 1–4 PM at The Baseball fields across from The Hive of Hope Mills, 3414 Bullard St. Event details, accessibility support, waivers, and volunteer preferences are included.
Participant Information
Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
This will help to place the participant in their age appropriate groups!
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Communication Method
Accessibility/Support Needs
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Secondary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Volunteer/Buddy Information
Volunteer/Buddy Name
Email
example@example.com
Phone if different
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Volunteer Roles
Availability
Experience
T-shirt Size
Additional Notes
Waivers and Acknowledgements
By checking the boxes below, the "participant" or "volunteer" acknowledge and agree to the Waiver of Liability set forth below.
Participation Acknowledgement
Liability/Risk Acknowledgement
Photo/Media Release
Code of Conduct
Parent/Guardian Consent
Additional Information and Contact Consent
How did you hear about the event?

Other
Anything else?
Consent to Contact
Should be Empty:

Kick it for Kwirkz Registration

Participant Information

Volunteer/Buddy Information

Waivers and Acknowledgements

Additional Information and Contact Consent