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10U "BRAWL IN THE FALL" 10/17/2020 - 10/18/2020

PLAYER INFORMATION

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Home Phone:

Birthdate:

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Grade:

PARENT/GUARDIAN #1

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EMail:

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PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

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Relationship to Player:

Insurance Carrier:

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WAIVER INFORMATION

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