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Registration Steps:
1. Accept Waiver   2. Complete Form   3. Submit Payment   4. Print Receipt

Test Soccer Club Registration
Girls U10

Myself (Joe Morgan)
Someone Else

( * indicates required information)
First Name: *
Last Name: *
Gender: *
Male   Female
Birthdate: *
(Age must be between 9 and 10 as of 8/1/2005.)
/ /   mm/dd/yyyy
Email: * click for help
Enter Email Again: *
Yes! Send me health and fitness news, information about local events and special offers. 
Home Phone: ext.
Address Line 1: *
Address Line 2:
City: *
State: *
  Outside USA: 
Country: *
Zip: *
Tell your friends and family about this activity!

(List email addresses separated by commas)
Did your child play in our league last year? *
Yes
No
Parent Information
Parent #1 First Name *
Parent #1 Last Name *
Parent #1 Address1 *
Parent #1 Address2
Parent #1 City *
Parent #1 State *
Parent #1 Zip *
Parent #1 Phone *
(269-555-1212)
Parent #1 Work Phone
(269-555-1212)
Parent #1 Email *
Parent #1 Relationship *
Parent #1 Occupation
Parent # 1: Which role or committee would you like to volunteer for? *
Team Coach
Team Assistant Coach
Team Parent
Referee
Concession Stand
Facilities/Maintenance
Website/Internet Help
I am unable to volunteer
Parent #2 First Name
Parent #2 Last Name
Parent #2 Work Phone
(269-555-1212)
Parent #2 Email
Parent #2 Occupation
Parent #2: Which role or committee would you like to volunteer for?
Team Coach
Team Assistant Coach
Team Parent
Referee
Concession Stand
Facilities/Maintenance
Website/Internet Help
I am unable to volunteer
Emergency Contact Information
Emergency Contact *
Emergency Contact Relationship *
(Example: Grandparent, Aunt, Uncle, etc.)
Emergency Contact Phone *
(269-555-1212)
Medical Comments
(Allergies, Medical Condition, Medical Concerns, etc.)
 

Create your Active.com User Account (recommended)
A user account allows you to register online in seconds by automatically filling in your personal information after logging in. An even greater benefit is complete access to your account history, past registrations, receipts, local events and customizable content.
Username: 
Password: 
Retype Password: 

Note: Active.com User Account does not provide Team Advantage Member benefits. To become an Team Advantage member see details on next page.

  

 
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