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