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Thank you for your interest in Coach Chelsea's Soccer and Wellness program. Please fill out the information below and someone will be in touch with you shortly.
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Child’s Full Name
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Does your child have a nickname? If so, please add below
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Child's age
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Parent Full Name
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Parent Phone
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Parent Email
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Who will pick up your child? (Full Name & Relation to Child)
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Please provide their phone number if applicable
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Would you like your child to have a uniform shirt? ($30)
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