Participant Child Information
Please fill out the following information for the participating child.

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Si necesita ver este formulario en otro idioma, abra https://translate.google.com, seleccione "Sitio web" y agregue bostonscores.org/register con el idioma deseado.

Si w bezwen wè fòm sa a nan yon lòt lang, louvri https://translate.google.com, chwazi "Sit Web," epi ajoute bostonscores.org/register ak lang ou vle.

Se você precisar visualizar este formulário em outro idioma, abra https://translate.google.com, selecione "Website" e adicione bostonscores.org/register com o idioma desejado.
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Student Name
hereinafter, “Student”
First Name *
Last Name *
Nickname
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
BPS ID Number
Has your child participated in Soccer for Success / Boston Scores before? *
Student's Phone (optional)
Student's Email
Student's Primary Language *
Medical Information
Allergies
Medical Concerns
Medications
Primary Care Physician
Physician Phone
Health Insurance Provider
Transportation Plan and Consent
If your child will be picked up by someone not listed on this form you must send a written note to their teacher.
Does your child have permission to walk, bicycle, or take public transportation home on their own? *
My child will get home after the program each day in the following manner:
Not to be picked up by
Grade Level for the 2022-2023 school year *
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