Club Football Registration

Full Name

DOB

Age/Grade

Gender

T Shirt Size

Short Size

Jersey #

• Full Name

• Phone Number

• Email Address

• Relationship to Athlete

• Secondary Emergency Contact (optional)

• Any allergies or medical conditions? (Y/N)

• If yes, please explain

• Is athlete cleared for physical activity? (Y/N)

• Are you using ESA funds for this registration? (Y/N)

• If yes, ESA Parent Name (if different)

• ESA Application Status (Applied / Approved / Pending)