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Team registration form

TEAM INFORMATION

* Team Name:

* Coach Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Cell Phone:

* Team website:

* Email:

* Gender:

* Assistant Coach First name:

* Lastname:

* EMail:

* Home Phone:

Work Phone:

* Cell Phone:

Assistant Coach #2 First name:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

*** Insert your waiver information here ***

I/we agree with the above *

* indicates required fields