WJSC Winter Indoor Soccer Registration
Player's First and Last Name (as they appear on birth certificate) *
Your answer
Player's Address (please hit return to separate response to 3 lines) *
Your answer
Player's Date of Birth *
MM
/
DD
/
YYYY
Playing Experience (years or none) *
Your answer
Current Soccer Club or recreation team (or none) *
Your answer
School Player Attends *
Your answer
Township player resides in (if different from mailing address) *
Your answer
Parent/Guardian information (parent #1) name, cell phone number, email address (please hit return to separate responses to 3 lines) *
Your answer
Parent/Guardian information (parent #2) name, cell phone number, email address (please hit return to separate responses to 3 lines)
Your answer
Emergency Contact Name and phone number other than a parent listed above *
Your answer
Medical Concerns for Player (or none) *
Your answer
How did you hear about West Jersey SC? *
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