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Registration Form
Username
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User Email
*
User Password
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Confirm Password
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Player info
First Name
*
Last Name
*
Birthdate (mm/dd/yyyy)
*
Gender
*
Male
Female
T-Shirt Size
*
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Player Position
*
Field Player
Goal Keeper
Player Allergies?
*
No
Yes
Does player require medications?
*
No
Yes
Player's Physician Name
Player's Physician Phone
Please list allergies and/or medications and/or past injuries
Allow call emergency services?
*
Yes
No
Location
Ted Hendricks Stadium
Milander Park
Champions Florida
SDG Soccer Complex
Parent info
First Name
*
Last Name
*
Phone
*
Medical Insurance Company
Policy Holder
Policy #
Address
*
Town / City
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Postcode / Zip
*
State / County
*
Privacy Policy
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