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DKINGHTS 13U PLAYER REGISTRATION
Parent/Guardian First Name:
(Required)
Parent/Guardian Last Name:
(Required)
Parent/Guardian Cell Phone:
(Required)
Email:
(Required)
Parent/Guardian 2 First Name:
Parent/Guardian 2 Last Name:
Parent/Guardian 2 Cell Phone:
Parent/Guardian 2 Email:
Player Information
First Name:
(Required)
Middle Name:
Last Name:
(Required)
Child Date of Birth
(Required)
Month
Day
Year
JERSEY NUMBER
Please enter a number from
0
to
99
.
IF PRESEASON PUT 0
School:
(Required)
Grade:
(Required)
Address:
(Required)
Street Address
Address 2:
Street Address
City:
(Required)
State:
(Required)
Zip / Postal:
(Required)
Upload Player Headshot
(Required)
Drop files here or
Select files
Max. file size: 1 GB.
Upload Government Issued ID
(Required)
Drop files here or
Select files
Max. file size: 1 GB.
Emergency Contact
Primary Emergency Contact Name:
(Required)
Primary Emergency Contact Phone Number:
(Required)
Primary Emergency Contact Relationship to Player:
(Required)
Secondary Emergency Contact Name:
Secondary Emergency Contact Phone Number:
Medical History
UPLOAD PROOF OF PHYSICAL
(Required)
Max. file size: 1 GB.
Does the player have any allergies that we need to be aware of? *
(Required)
Select
Yes
No
Does the player have any other medical conditions that we need to be aware of? *
(Required)
Select
Yes
No
If you answered yes please explain:
REGISTRATION
(Required)
Price:
Payment Method
*
PayPal Checkout
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
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