REGISTRATION FORM
Program Training *
GUARDIAN INFORMATION
Father's name *
Your answer
Mother's name *
Your answer
Mailing address *
Your answer
Home phone *
Your answer
Father's Cell phone *
Your answer
Mother's Cell phone *
Your answer
Father's email *
Your answer
Mother's email *
Your answer
PLAYER INFORMATION
Player's name *
Your answer
Gender *
Player's birthdate *
MM
/
DD
/
YYYY
School name *
Your answer
Current level of play (e.g.. U-14 Metro) *
Your answer
Emergency contact #1 (name and number) *
Your answer
Emergency contact #2 (name and number) *
Your answer
MEDICAL AND INJURY HISTORY
Medical *
Your answer
Injuries *
Your answer
TYPE OF COACHING REQUIRED
Group or team roster (first and last names)
Your answer
What are your goals for the training sessions? *
Your answer
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