Registration - Fall 2008
                                                                                                                                                                                                                                                               
Player's Birthdate:    Grade as of October 1, 2008*:
 
     

 Registration Information (* Denotes a required field)
First Name*: Last Name*:
Address*:
City*: State*:   Zip*:
Phone*: Cell Phone: Email*:
Parent Name*: Phone*:
Shirt Size*: Short Size*: Sex*:
To be eligible to play, all players, coaches and parents must sign a “Character Counts” form as mandated by The Jefferson Township. The “Character Counts” form is located on the “Signature Form”. “Character Counts” information can also be found on this web site. Please see the Home page for a link.

Players who wear glasses are recommended to obtain goggles. Special requests: (example: request coach or carpool with another player); Special requests will try to be honored but cannot be promised.       

Are there any medical conditions that could affect your child's play?*    If yes, please explain below.
Emergency Number*: