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2018 Athletics Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Age (on August 31):

* Birthdate:

* School:

* Grade:

* Height:

* Weight:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

Home Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

Signature:

Date:

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

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