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: --

 



5

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


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