Michigan Burn Soccer
30845 23 Mile Road Chesterfield MI 4807 Phone number: 586.949.6266 http://www.michiganburnsoccer.com
Online Player Registration Form
Parent or Guardian Name: *
Player's Name: *
Player's Date of Birth *
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Player's Age: *
Player's Gender: *
Please select one of the following options *
Address: *
City: *
State: *
Zip Code: *
Home phone number: *
Cell phone number:
E-mail address: *
How did you hear about The Michigan Burn? *
If you selected Friend, Travel League or Other, please list specific name here:
Comments:
I hereby give permission and certify that team members are in good health and able to participate in all Michigan Burn activities. By selecting the SUBMIT button, I release coaches, staff, and all others associated with Michigan Burn activities of all Liability for any injury or illness incurred by team members at Michigan Burn activities. *
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