Blaine Boys Soccer Information Form
This Information form is used for the coaching staff only! This information is used for everyday operations such as spelling of your son's name, Parents night name tags, Medical Information for the coaches to carry at all games, share with college coaches, etc...

Before you start filling out this form pleas review the Boys Soccer Handbook before you start. http://bit.ly/BHSBSoccerHB

Please make sure you use proper capitalization

THIS IS NOT HIGH SCHOOL SOCCER REGISTRATION!

First Name *
Player
Your answer
Last Name *
Player
Your answer
Graduation Year *
Year that you will Graduate from High School
Your answer
Grade *
Enter the Grade the player will be in this fall
Position *
Select your first choice position: D = Defender, CM = Center Midfield, OM = Outside Midfielder, F = Forward, K = Keeper
Player Email Address *
If no email enter: X@com
Your answer
Home Phone *
555-232-2222
Your answer
Player Cell Phone Number *
Please enter number just like this: 555-555-5555
Your answer
Father's First Name *
Your answer
Father's Last Name *
Your answer
Father's Email Address *
If none enter: X@com
Your answer
Father's Cell *
Please enter like this: 555-555-5555
Your answer
Mother's First Name *
Your answer
Mother's Last Name *
Your answer
Mother's Email Address *
If none enter: X@com
Your answer
Mother's Cell *
Please enter like this: 555-555-5555
Your answer
Street Address *
Use full and proper punctuation: 12555 University Avenue NE
Your answer
City *
Use full and proper punctuation: Blaine, Coon Rapids, Ham Lake
Your answer
Zip Code *
Your answer
Emergency Contact Name *
John Smith
Your answer
Emergency Contact Phone *
Please enter like this: 555-555-55555
Your answer
Alternate Emergency Contact Name *
John Smith
Your answer
Alternate Emergency Contact Phone *
Please enter like this: 555-555-55555
Your answer
Physician Name *
Your answer
Emergency Consent: *
Consent for Medical Treatment As the parent or legal guardian of a participant in Blaine High School Soccer, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent. Check the box Yes or No below.
Required
Personal Information Release: *
I agree and give my permission to release the following information to coaches and/or recruiters of colleges and universities: Name, address, phone number, email address, stats, and physical attributes of the student athlete along with the names, address, phone, and email address of the parents/guardians. I also agree to have my son's name on the Boys Soccer Website as a player in our program, which his stats may be listed. (Goals, Assists, Saves, etc...) Blaine High School, its faculty and staff, the Anoka-Hennepin ISD #11, and the Blaine High School Coaching Staff are not held liable for the release of information permitted by this agreement. This release form stays in effect until revoked by me in writing. Check the box Yes or No below.
Required
Handbook Review *
I acknowledge that I have received and read Blaine High School Boys Soccer Handbook. Check the box Yes or No below.
Required
Social Media *
I understand that freedom of speech is not unlimited. The on-line social network sites are NOT a place to say and do whatever I want without repercussions. The information I post on a social network sites is considered public information. I agree to protect myself by maintaining a positive self-image of myself, team, community, school, and staff. Check the box Yes or No below.
Required
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