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Fall 2012 Tryout Registration
(please fill in all fields)
Player
First name
:
Last name
Gender
Select?
Male
Female
Age group
Select?
Under 9
Under 10
Under 11
Under 12
Under 13
Under 14
Under 15
Under 16
Under 17
Birthdate
(MM/DD/YYYY):
Grade
(in fall)
School
Experience
(years)
Club
Home phone
Parents
First Name:
Last Name:
Email:
Cell Phone:
Role:
Select?
None
Team Parent
Assistant Coach
Head Coach
Head or Assistant Coach
Other
First Name:
Last Name
Email:
Cell Phone:
Role:
Select?
None
Team Parent
Assistant Coach
Head Coach
Head or Assistant Coach
Other
Address Information
Address
City
State
Zip
Township
Select?
North Coventry
South Coventry
East Coventry
East Vincent
West Vincent
Warwick
Spring City
East Nantmeal
Other
Medical insurance
Policy number
Emergency contact
Emergency phone
Season Information
Will you accept team placement (regardless of team)?
Select?
Unsure
No
Yes
Is your child trying out for other teams?
Select?
Unsure
No
Yes
List teams:
Are you interested in playing a winter indoor season?
Select?
Unsure
Not Interested
Will Attempt To Make it
Fully Committed
Are you interested in Winter team training?
Select?
Unsure
Not Interested
Will Attempt To Make it
Fully Committed
Are you interested in playing a spring season (Games Sundays)?
Select?
Unsure
Not Interested
Will Attempt To Make it
Fully Committed
Are you interested in playing in spring cups (Saturdays)
Spring cup
Select?
Unsure
Not Interested
Will Attempt To Make it
Fully Committed
Are you interested in pickup games? (free play, uncoached but supervised, not bound to team or gender)
Select?
Unsure
No
Yes
Is your child interesed / willing to play Goalkeeper?
Select?
No
If Asked
Yes
What other sports do you play?
Please list any known summer vacations plans:
Medical Condtions:
Is there anything else we need to know? (club or coaches)?
