Football Clinic - Fall 2020
Football Clinic Registration
Email address *
Child's name *
Child's age *
Shirt Size *
Mother's Name
Father's Name
E-mail Address
Primary Phone *
Secondary Phone
Address *
City *
State *
Zip Code *
Child's Diagnosis *
Child's Doctor *
Emergency Contact *
Emergency Phone *
Please read and select all of which will apply in order to better serve your child: *
Required
Please provide any helpful strategies for our staff to assist your child in adjusting:
Are there any other special considerations you would like us to know?
Has there been any changes in your child’s medical condition or status since the previous program?
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