2023 Soccer Clinic 2023-Soccer-Clinic-2 2023 Soccer Clinic Player's Name(Required) First Last Full Address(Required) Street Address City Township AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) School(Required) Grade(Required) Age(Required) Gender(Required) Parents' Names or Person Registering Child (Other than parent)(Required) Shirt Size(Required) Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult Extra Large Age group(Required) 4-5 years old 9:00-10:00 am 6-8 years old 10:15-11:15 am Select One(Required) Resident $50 Non-Resident $55 Registration Deadline - January 27th ($15 late fee after this date until February 3rd) Registration Closes February 3rd.My signature on this form verifies that I understand Thomas Township, its employees and volunteers, shall not be responsible for any injury to my child while participating in this basketball program. I waive and release Thomas Township from any and all claims.Concussion Information Acknowledgement(Required) I agree that I have read the concussion information provided above.Parent / Guardian Signature(Required)Date(Required) MM slash DD slash YYYY Volunteer Coach Name First Last Coach's PhoneShirt Size
