registration - demo

Player  Information
NAME (Last):	* required
NAME  (First):	* required
NAME  (Middle initial):
ADDRESS:	* required
CITY:	* required
STATE:	* required
ZIP:	* required
GENDER:	Select... Female Male
BIRTHDAY: ((Use format MM/DD/YYY))	* required
AGE  GROUP: (Click HERE for age groupings)	Select... U6 U8 Boys U8 Girls
GRADE: (for season registering)	* required
LAST 4 DIGITS OF PLAYER SSN: (Only for U12 and older)????
EMERGENCY  CONTACTS: (Other than Parents / Guardians below)
Parent / Guardian 1 Information
NAME (Last):	* required
NAME (First):	* required
TELEPHONE  (Primary):	* required
TELEPHONE  (Secondary):
EMAIL  ADDRESS:	* required
WILL  YOU  HELP?: (Please check all that apply)	I am willing to Coach   I am willing to assist   I have previous coaching experience   Do you have a coaching license?  If so, please indicate level: A B C D E F Select... Is your background check still valid? (required for coaches, assistants and helpers - click HERE for more info) Select... Yes No Unknown I am willing to serve on Parents Auxiliary   I would like to referee / become a referee
Parent / Guardian 2 Information
NAME (Last):
NAME (First):
TELEPHONE (Primary):
TELEPHONE (Secondary):
EMAIL  ADDRESS:
WILL  YOU  HELP?: (Please check all that apply)	I am willing to Coach   I am willing to Assist   I have previous coaching experience   Do you have a coaching license?  If so, please indicate level: A B C D E F Select... Is your background check still valid? (required for coaches, assistants and helpers - click HERE for more info)) Select... Yes No Unknown I am willing to serve on Parents Auxiliary   I would like to referee / become a referee
CONSENT & RELEASE:	I, the undersigned parent or legal guardian of this child, do consent... Please enter  'Yes' or 'No'  * required Please provide the following as your electronic signature: Email address:  * required Month and Date of your birthday (MM/DD):  * required