Published on Davis Legacy Soccer Club (
http://dysl.org
)
Summer Camp 2008 Registration Form
Davis Legacy Summer Camp Online Registration
Personal Information
First Name:
*
Last Name:
*
Birthday:
*
month
January
February
March
April
May
June
July
August
September
October
November
December
day
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31
Email Address:
*
Required to send confirmation email
Address:
*
City:
*
Zip Code:
*
Father
Father's Name:
Father's Day Phone:
Father's Cell:
Mother
Mother's Name:
Mother's Day Phone:
Mother's Cell:
Emergency Information
Emergency Contact
In an emergency when parent/guardian cannot be reached, please contact the following:
Contact Name:
*
Contact Phone:
*
Contact Cell:
Relationship:
*
Allergies:
Physician
Physician Name:
Physician Phone:
Insurance
Medical/Hospital Insurance Company:
*
Insurance Phone:
*
Policy Holder's Name:
*
Policy Number:
*
