Participant Child Information
Please fill out the following information for the participating child.

If you need to view this form in another language, right click on the page and select "Translate to..." and select the language you would like to read it in.

Si necesita ver este formulario en otro idioma, haga clic derecho en la página y seleccione "Traducir a ..." y seleccione el idioma en el que le gustaría leerlo.

Si ou bezwen wè fòm sa a nan yon lòt lang, klike sou dwa sou paj la epi chwazi "Tradui nan ..." epi chwazi lang ou ta renmen li a nan.
Student Name
hereinafter, “Student”
First Name *
Last Name *
Nickname
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
BPS ID Number
Grade Level *
Which school / program will the participating student attend in Fall 2020? *
Which program(s) is/are your child interested in participating in? *
Check all that apply. NOT ALL OPTIONS ARE AVAILABLE AT ALL SITES, please confirm with your Site Coordinator.
Required
Has your child participated in Soccer for Success / Boston Scores before? *
Student's Phone (optional)
Student's Email *
This question is required so coaches can send virtual login information to students.
Student's Primary Language *
Medical Information
Allergies
Medical Concerns
Medications
Primary Care Physician
Physician Phone
Health Insurance Provider
Transportation Plan and Consent
If your child will be picked up by someone not listed on this form you must send a written note to their teacher.
Does your child have permission to walk, bicycle, or take public transportation home on their own? *
My child will get home after the program each day in the following manner:
Not to be picked up by
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