HOME \ HIGH SCHOOL - EMAIL REGISTRATION  
EMAIL REGISTRATION
Name:
Address:
City:
 Postal Code:
Home Phone:
 Player's Cell:
Grade(as of Sept 2007):
Birthdate:
Email address:
Parent/Guardian Information:
Mother's Name:
Address (If different then above)
City:
 Postal Code:
Cell:
Home Phone:
Email:
Daytime Phone:
Father's  Name:
Address (If different then above)
City:
 Postal Code:
Home Phone:
 Cell:
Daytime Phone:
Email:
Family Physician:
Phone:
BC Medical Card:
Please use this space to comment on any medications or medical or allergy concerns:
Soccer Training Information:
Coach:
Club Team:
Coach's Phone:
Email:
Any Additional soccer and/or personal training programs:
Other Sports interests:
Copyright 2006 PASS Play Active School Soccer