Spring Soccer Registration 2018

Name of participant *
Prefix
First *
Last *
Suffix
Division

(For the Under 5, you child must already be four years old at time of registration)
*
 Under 5 Co-Ed (Junior K) 
 Under 6 Co-Ed (Senior K) 
 Under 8 (1st-2nd grade) 
 Under 10 (3rd-4th grade) 
Mother's name
Prefix
First
Last
Suffix
Father's name
Prefix
First
Last
Suffix
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Cell phone (mother)

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-
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-
####
Cell phone (father)

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-
###
-
####
Email *
Date of birth for participant *

MM
/
DD
/
YYYY
Grade *
Gender of participant *
 Male 
 Female 
School attending: *
Emergency contact and relation *
Phone number (emergency contact) *

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-
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-
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Are you,as a parent or guardian, willing or interested in coaching your child's team? *
 Yes (no registration fee required if willing to coach) 
 No 
Do you have a current Second Baptist soccer uniform? *
 Yes 
 No 
If "yes", what is the jersey number on the back?
Need a uniform? Check one:
 Youth small 
 Youth medium 
 Youth large 
 Adult small 
I hereby release and discharge Second Baptist Church, its agents, employees and coaches from all claims, actions, causes of action, or demands which I, my heirs, for any and all injuries known or unknown which my child has or may incur by participating in *
 (I have read this and agree to all of these terms) 
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