Parent / Guardian Name *

First Name

Last Name

Parent / Guardian Phone Number *

(###)

###

####

Students Name *

First Name

Last Name

Students Phone Number

(###)

###

####

Sport that Student is Interested in *

Fall: Soccer & Basketball Spring: Soccer & Tennis

Soccer

Basketball

Tennis

Race *

Native American or Alaska Native

Asian

Black or African American

Hispanic or Latinx

White/Caucasian

Unknown

Other

Address *

If you are homeless please input the school address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country