Registration Form

* Indicates required field

Athlete's Name *

First

Last

Parent / Guardian *

First

Last

Email *

T-Shirt Size *

Team Placement *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Athlete's Phone Number *

Parent Phone Number *

Nearest Relative or Friend (Emergency Contact) *

First

Last

Phone Number *

Insurance *

Relationship *

Group # *

Preferred Hospital Provider *

Medical Notes: Please inform us if the participant has any of the following special medical concerns: *

Other *

List any Daily Medication: *

I give my consent for emergency medical aid to be provided for my son/daughter *

First

Last

Date MM/DD/YY *

Submit