| ELIGIBILITY (Admin-only) |
|
|---|---|
| Parent/Guardian First Name: | Kai |
| Parent/Guardian Last Name: | Spence |
| Parent/Guardian Cell Phone: | 7579495529 |
| Email: | jusmenmy3.ks@gmail.com |
| Player Information | |
| First Name: | Kaiden |
| Last Name: | Dancy |
| Child Date of Birth | 05/10/2012 |
| JERSEY NUMBER | 17 |
| School: | Hugo Owen’s Middle |
| Grade: | 6 |
| Address: | 2824 North Creek Drive |
| City: | Chesapeake |
| State: | Virginia |
| Zip / Postal: | 23323 |
| Upload Player Headshot |  |
| Upload Government Issued ID |  |
| Emergency Contact | |
| Primary Emergency Contact Name: | Michael Dancy |
| Primary Emergency Contact Phone Number: | 7572926318 |
| Primary Emergency Contact Relationship to Player: | Dad |
| 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 |
