PREDATORS 11U 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)

JERSEY NUMBER

Please enter a number from 0 to 99.

IF PRESEASON PUT 0

School:

Grade:(Required)

Address:(Required)

Address 2:

City:(Required)

State:(Required)

Zip / Postal:(Required)

Upload Player Headshot

Max. file size: 1 GB.

Upload Government Issued ID

Drop files here or

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)

Does the player have any other medical conditions that we need to be aware of? *(Required)

If you answered yes please explain:

REGISTRATION(Required)

Price:

ASSOCIATION CODE

Total

Payment Method*

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