Uptown Soccer Sign Up
Please complete the details below to register with Uptown Soccer
Player's First Name / Nombre del Niño *
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Player's Last Name / Apellido *
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Player's Age / Edad *
Your answer
Address / Direccion *
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City / Ciudad *
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Zip Code *
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Cel Phone # / celular *
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Alternative Phone # / Alternativo numero de telfono *
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Date of Birth / Fecha de nacimiento *
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Email
Your answer
Male / Female / Niño/a *
Your answer
Parent Full Name / Nombre del Padre *
Your answer
Emergency Contact Name / Contacto emergencia *
Your answer
Emergency Contact Phone # *
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Race / Ethnicity of Child / Etnicidad del niño
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Does Child receive free / reduced price lunch at school? / Recibe almuerzo gratis en escuela?
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Any Health / Medical concerns we should be aware of? / Algunas condiciones medicas? *
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Liability Waiver *
Please read the liability waiver here: http://goo.gl/hLOLX
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