EmailMe Form - MLS GO | Registration form

LOCATION PROGRAM

Your Selected Program

PARENTS INFORMATION

#1: Parents Name

#2 Parents Name

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Cell Phone Number #1 *

### - ### - ####

Cell Phone Number #2

### - ### - ####

Email #1 *

Email #2

How many Children are you registering? *

1 child only

2 children

3 children

Would you (or another family member) want to be become a Volunteer Coach? *

Yes - I want to Volunteer

No - not this time

*You will be Trained, Fingerprinted and Screened by the City Prior to Coaching and your Child will Discounted/Waived

CHILD #1 INFORMATION

#1: Child's Full Name *

Date of Birth *

School Name *

School Grade *

Shirt Size *

Fav Sports *

Top 3 Sports

CHILD #2 INFORMATION

#2: Child's Full Name

Date of Birth

School Name

School Grade

Shirt Size

Fav Sports

Top 3 Sports

CHILD #3 INFORMATION

#3: Child's Full Name

Date of Birth

School Name

School Grade

Shirt Size

Fav Sports

Top 3 Sports

INSURANCE INFORMATION

Primary Insurance Details
(your childs insurance carrier and policy number)

Medical Concerns

HOW DID YOU HEAR ABOUT US?

Let Us Know! *

This will help us in our outreach marketing

COMMENTS

Comments

Any Specific questions you may have?

PAYMENTS

Will you want to Register Now or Apply for funding *

Please note: GO FUND will let you know if you received funding no more than 3 weeks prior to start date.
APPLY NOW

TERMS & CONDITIONS

I have read and agree to the Terms of Service *

Yes, I agree.

Your child must be covered by a private insurance, you must provide us with proof of your child’s insurance coverage. I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organizers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the course, other than imposed by law. I also allow USC to take photos for advertising and promoting purposes only; if you do not want your childs photo to be taken please email unitedsc.us@gmail.com I confirm that my personal insurance is correct and bears responsibility in case of accidents. I confirm that I am legally entitled to give this consent and understand all payments received are non-refundable.

I Understand that All Fees are Non-Refundable *

Yes, I agree.