MERLIN SOCCER CLUB Application / Aplicaci�n |
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Family Information |
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Parent Name / Padres |
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Street Address / Direccion |
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Town / City / Ciudad |
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State / Estado |
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Zip / Codigo Postas |
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Home Phone / Telefono |
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Daytime Phone / Telefono |
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E-Mail / Correo Electronico (Important): |
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Family Doctor Doctor Phone |
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Player Information |
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Player Name / Nombre |
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Age / Edad |
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Gender / Sexo |
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Date of Birth / Fecha Nac |
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Current Team |
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Are you Goalkeeper: Yes No |
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Positions Played |
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PARENT / GUARDIAN CONSENT AND WAIVER I hereby represent that the above information is true and accurate and the named applicant is in good health and has my permission to participate in the Merlin Soccer Club. I acknowledge that soccer is a contact sport and that there is a risk of injury from participating in the camp and its related activities. I HEREBY WAIVE AND RELEASE Merlin Soccer Club, Merlin Villagomez and its agents, servants and employees from any and liability and claims for damage. In the event of an emergency I hereby give permission to such Medical personnel as necessary to render treatment. ----------------------------------------- ------------------ Parent/Guardian Signature Date A deposit of $176 is required with each application. Please return application and checks payable to: MerlinSoccerClub 727 Jackson Ave, #2 Elizabeth NJ 07201 |
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