VIRGINIA BEACH DESTROYERS 8U PLAYER REGISTRATION

Parent/Guardian First Name:(Required) Parent/Guardian Last Name:(Required) Parent/Guardian Cell Phone:(Required)Email:(Required)

Parent/Guardian 2 First Name: Parent/Guardian 2 Last Name: Parent/Guardian 2 Cell Phone:Parent/Guardian 2 Email:

Player Information

First Name:(Required) Middle Name: Last Name:(Required)

Child Date of Birth(Required)

Month

Day

Year

JERSEY NUMBERPlease enter a number from 0 to 99.IF PRESEASON PUT 0School: Grade:(Required)

Address:(Required)

Street Address

Address 2:

Street Address

City:(Required) State:(Required) Zip / Postal:(Required) Upload Player Headshot(Required)
Drop files here or

Max. file size: 1 GB.

Upload Government Issued ID
Drop files here or

Max. file size: 1 GB.

Emergency Contact

Primary Emergency Contact Name:(Required) Primary Emergency Contact Phone Number:(Required) Primary Emergency Contact Relationship to Player:(Required) Secondary Emergency Contact Name: Secondary Emergency Contact Phone Number:

Medical History

UPLOAD PROOF OF PHYSICAL(Required)Max. file size: 1 GB.Does the player have any allergies that we need to be aware of? *(Required)Does the player have any other medical conditions that we need to be aware of? *(Required)If you answered yes please explain:REGISTRATION(Required)

Price:

Coupon Total

Payment Method*

MasterCardVisaSupported Credit Cards: MasterCard, Visa
Card Number
Expiration Date

Security Code

Cardholder Name