Harlem Elite Intake Survey
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Contact # *
Player's Full Name *
Email *
Date Of Birth *
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Player Age *
Players Grade *
Player is *
This form is being completed *
Has your child ever played football? *
If yes, what is your child's level of experience? *
Does your child have any conditions that can impede them from playing? *
What do you want to get out of this experience? *
Parent/Guardian Full Name *
Emergency Contact Full Name
Do you have any questions for coach Jude?
Today's Date *
MM
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