| ELIGIBILITY (Admin-only) |
|
|---|---|
| Parent/Guardian First Name: | Kai |
| Parent/Guardian Last Name: | Spence |
| Parent/Guardian Cell Phone: | 7577129435 |
| Email: | jusmenmy3.ks@gmail.com |
| Player Information | |
| First Name: | Michael |
| Last Name: | Dancy Jr |
| Child Date of Birth | 03/30/2011 |
| JERSEY NUMBER | 9 |
| School: | Hugo Owen’s Middle School |
| Grade: | 7 |
| Address: | 2723 Janice Lynn Ct |
| City: | Chesapeake |
| State: | Virginia |
| Zip / Postal: | 23323 |
| Upload Player Headshot |  |
| Upload Government Issued ID |  |
| Emergency Contact | |
| Primary Emergency Contact Name: | Shelley Spence |
| Primary Emergency Contact Phone Number: | 7574501982 |
| Primary Emergency Contact Relationship to Player: | Grandma |
| Medical History | |
| UPLOAD PROOF OF PHYSICAL |  |
| Does the player have any allergies that we need to be aware of? * | No |
| Does the player have any other medical conditions that we need to be aware of? * | No |
| REGISTRATION | REGISTRATION, Qty: 1, Price: $15.00 |
| Payment Method | PayPal Checkout |
