REGISTRATION FORM

(2021-2022)
NOTICE TO PARENTS & ATHLETES: *
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TRYOUTS ARE PRIVATE. *
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TODAYS DATE *
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FIRST NAME *
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LAST NAME *
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Gender:
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Birthday: *
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Age *
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Participant Email *
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Participant Phone *
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School
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Grade
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Home Address *
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Child lives with:
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Other
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CONTACT #1

Name (First/Last) *
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Relationship *
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Address *
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Home Phone *
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Cell Phone *
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Work Phone *
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Employer *
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Email *
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CONTACT #2

Name (First/Last) *
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Relationship *
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Address *
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Home Phone *
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Cell Phone *
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Work Phone *
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Employer *
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Email *
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EMERGENCY CONTACT (Other than Parent/Guardian)

Name (First/Last) *
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Relationship *
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Address
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Home Phone *
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Cell Phone *
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PARTICIPANT’S MEDICAL HISTORY & INSURANCE INFORMATION

List ANY and ALL Disabilities and/or Allergies
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Medications Taken & Time of Day
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Primary Care Physician
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Phone
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Insurance Carrier
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Policy #
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Group #
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Phone
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Just to prove you are a human, please solve the equation: 16 - 14 = ?
Enter the equation result to proceed
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