2019 Children's Soccer Clinic Registration
Please Complete a Form for Each Child and Volunteer Participating
Child's First Name *
Your answer
Child's Last Name *
Your answer
Parent/Guardian Name *
Your answer
Street Address *
Your answer
Mailing Address (if different)
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
e-Mail Address:
Your answer
Child's Age: *
Your answer
Primary Emergency Contact Name: *
Your answer
Primary Emergency Contact Phone Number: *
Your answer
Secondary Emergency Contact Name:
Your answer
Secondary Emergency Contact Phone Number:
Your answer
Dismissal Information: Who may pack-up your child at the end of the clinic? *
Your answer
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