DREAAM Soccer Sign-up
Sign up your kid up here to play indoor soccer this starting on 4/2/22
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Email *
Student Information
First Name: *
Last Name: *
Nickname:
Date of Birth: *
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Age: *
Grade: *
Race: *
Home Address: *
City: *
State: *
Zip: *
Height: *
T-shirt Size: *
Family Information
Mother/Female Guardian: *
Email: *
Employer: *
Daytime/Work Phone: *
Cellular: *
Father/Male Guardian: *
Email: *
Employer: *
Daytime/Work Phone: *
Cellular: *
Student lives with (check all that applies): *
Required
Home Language: *
Country of Birth: *
Family Annual Income: *
Emergency Information
Emergency Contact: *
Relationship: *
Daytime Phone: *
Daily Medication(s): *
Will the medication(s) need to be administered during the daytime?: *
Health Restrictions: *
Health Restrictions: *
Allergies: *
IMPORTANT. In an extreme medical emergency, your child will be taken by ambulance to the hospital that you identify below. Please select a hospital: *
In case of a minor accident, efforts will be made to contact you for direction. All medical fees are the responsibility of the parents or guardians.
By checking the box below, I electronically sign this form and certify that all information provided is accurate: *
Required
Date of electronic signature: *
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