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Euro Soccer Clinic Registration

Player's Information
First Name	Last Name
Date of Birth (dd/mm/yyyy)	Boy Girl
Position most-often played		example: forward, midfielder, don't know, etc.
Current Team	Age Group of Current Team
Parent/Guardian/Emergency Contact Information
Full Name			Relationship to Player
Address

City Zip Code
Home Phone			10 Digit phone numbers please! example: 000-000-0000 Be sure to include the area code
Work Phone
Cell Phone
Email
SESSION(s) -			IF CHOOSING ONE TRAINING NIGHT ONLY Please specify the date in the box below

I hereby give permission for any and all medical attention to be administered to my child in the event of accident, injury, sickness, etc., until such time as I may be contacted. I assume the responsibility for the payment of any such treatment.
Agree	Do Not Agree

CODE HINT: number seven, number three, lowercase "t" Please enter the security code shown:			Enter the proper letters or numbers as are indicated as the CODE HINT. The security code must be entered or the form will not be submitted. If you have trouble with your entry, just click "new image" to try a different one. Any problems, contact webmaster@westpascofc.com
REGISTER NOW	Clear Form and start over