Elite GK Camp Registration

FASA Elite Goalkeeper Academy
Weekly Training Program Registration

Note: Use this form to pre-register. Payment will be due at the first session attended

1. PLAYER INFORMATION:

Program:

Please list Intermediate or Advanced (or leave blank if not sure - you will be placed)

Is Player on a FASA Team? (Y/N):

First Name:

*Last Name:

*Gender:

*Birth Date (mm/dd/yyyy): / /

*Street Address:

*City:

*State:

*Zip Code:

*Home Phone: --

2. CONTACT INFORMATION:

An e-mail address is required and very important for club announcements, game cancellations, etc.

*E-mail:

*E-mail (Verify by retyping):

I do not have an E-mail:

3. PARENT/GUARDIAN INFORMATION:

Parent/Guardian #1

*First Name:

*Last Name:

Home Phone: --

Work Phone: -- ext.

*Relationship:

Parent/Guardian #2

First Name:
Last Name:
Home Phone:	--
Work Phone:	-- ext.
Relationship:

4. EMERGENCY INFORMATION:

*Emergency Contact:

*Emergency Phone Number: --

Please review all information entered for accuracy and completeness, then click on the appropriate button below to continue the registration process.

Program:
Please list Intermediate or Advanced (or leave blank if not sure - you will be placed)
Is Player on a FASA Team? (Y/N):
First Name:
*Last Name:
*Gender:
*Birth Date (mm/dd/yyyy):	/ /
*Street Address:
*City:
*State:
*Zip Code:
*Home Phone:	--

*E-mail:
*E-mail (Verify by retyping):
I do not have an E-mail:

*First Name:
*Last Name:
Home Phone:	--
Work Phone:	-- ext.
*Relationship:

Pete Cinalli, Director of Coaching FASA Hotspurs. All rights reserved. Revised: August 06, 2007 .

Pete Cinalli, Director of Coaching
FASA Hotspurs. All rights reserved.
Revised: August 06, 2007 .