- Required fields are colored yellow.

Participant Information

First Name:

Last Name:

Address:

City:

Zip:

Email:

Home/Cell Phone (###-###-####):

Grade (10-11 school year):

Gender: F M

DOB (MM/DD/YY):

Church (if you regularly attend - optional):

Preferred jersey size (they will be sized at evaluations): YS YM YL S M L

Player Information Notes (allergies, medical conditions, etc.):

Parent/Guardian Infomation

Please list at least one guardian and an emergency contact (if not parent/guardian).

Father/Mother/Guardian Name:

Father/Mother/Guardian Work/Cell Phone:

I would like to assist Upward by: None Coach Referee Team Parent

Father/Mother/Guardian Name:

Father/Mother/Guardian Work/Cell Phone:

I would like to assist Upward by: None Coach Referee Team Parent

Emergency Contact Name:

Emergency Contact Daytime Phone:

Emergency Contact Evening Phone:

How many season has your child played soccer?

If appropriate, please choose one night your child cannot practice: None Monday Tuesday Thursday

If practice were to start at 5:15pm, would you be able to make it? Yes No

How did you hear about Upward? Word of mouth TV Commercial Flyer During church Website

*You can purchase shorts for an additional $15. Please check the box below if you'd like to order shorts (they will be sized at evaluations):

By checking this box, you agree that you have read the following parental agreement and agree to its terms and conditions.