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

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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.

Se você precisar visualizar este formulário em outro idioma, clique com o botão direito na página e selecione "Traduzir para ..." e selecione o idioma no qual deseja lê-lo.
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Student Name
hereinafter, “Student”
First Name *
Last Name *
Nickname
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
BPS ID Number (optional)
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
We intend to play inter-scholastic games in 2021-22 if conditions allow. These questions allow you to consent to which activities which inter-scholastic activities you are comfortable having your child participate in. *
Grade Level for the 2021-2022 school year *
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