Last Name:

First Name:

Address: Number & Street

                City         State         Zip

Home Phone Number

Player Cell Phone Number

Parent e-mail

Player e-mail

Date of Birth         

Homeroom         

Height          feet          inches    Weight lbs

Place of Birth: City

                       State

                       Country

Year Entered 9th Grade         

Name of Parents or Guardian

Emergency Contact Name Phone Number

Soccer Position Striker Midfield Defender Keeper

Soccer Experience:

 

 

 

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