SOCCER 2008 REGISTRATION

 

E-mail Address: *
Participants Name *
Address *
City *
State *
Zip *
Parents Names *
Home Phone *
Dad Work *
Dad Cell
Mom Work *
Mom Cell *
Date of Birth
Age
Sex *Male
Female
School *
Grade *
Emergency Contact Name *
Emergency Contact Phone Number *
Medical Concerns that should be known in case of emergency *
Church You Attend *
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 the activity. *
I have read this release and AGREE to its terms.
I have read this release and DISAGREE to its terms.
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