| ELIGIBILITY (Admin-only) |
|
|---|---|
| Parent/Guardian First Name: | Marvin |
| Parent/Guardian Last Name: | Ford |
| Parent/Guardian Cell Phone: | 7577398145 |
| Email: | nvygunn3r@gmail.com |
| Player Information | |
| First Name: | Brayden |
| Last Name: | Ford |
| Child Date of Birth | 10/31/2011 |
| JERSEY NUMBER | 59 |
| School: | Cape Henry |
| Grade: | 6 |
| Address: | 316 Jake Lane |
| City: | Chesapeake |
| State: | Virginia |
| Zip / Postal: | 23320 |
| Upload Player Headshot |  |
| Upload Government Issued ID | IMG_1083.heic |
| Emergency Contact | |
| Primary Emergency Contact Name: | Alicia Ford |
| Primary Emergency Contact Phone Number: | 7576396508 |
| Primary Emergency Contact Relationship to Player: | Mother |
| 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 |
