CLUB CAMP ONLINE REGISTRATION
JULY 30 - AUGUST 3, 2012
(All Fields Must Be Filled In)
Last Name
First Name
Street
City
Postal Code
Gender
Male
Female
Home Phone Number (xxx-xxx-xxxx)
E-mail Address
Year Of Birth
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
Month of Birth
January
February
March
April
May
June
July
August
September
October
November
December
Day of Birth
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Club Played For
Position Played
School Attending in September 2011
Parents' Name(s)
Parents' Contact Phone Number
Emergency Contact
Emergency Contact Phone Number
T-Shirt Size
Youth X-Small
Youth Small
Youth Medium
Youth Large
Youth X-Large
Small
Medium
Large
X-Large