Southland FC Registration Form AWS

Southland FC Registration Form Player’s First Name: Player’s Last Name: Date of Birth: Gender: Age Group Trying Out For: Recreation Seasons Played: Previous Club: Seasons played: Primary Positions Played: Address:

City:

Home Phone Number: Contact Email Address: Mother’s Name:

Mother’s Cell:

Mother’s Email: Father’s Name:

Father’s Cell:

Father’s Email: Emergency Contact:

Emergency Phone:

Zip: