2006 / 2007 On-line Registration 

Note: * denotes required fields.

PLAYER INFORMATION:
* Players Full Name:
Nick Name:
*Gender:	-CHOOSE- Male Female
*Date of Birth (mm/dd/yyyy):	--Month-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / --Day-- 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 / --Year-- 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
*Age Group:	-CHOOSE- U9 (8/1/97 - 7/31/98) U10 (8/1/96 to 7/31/97) U11 (8/1/95 to 7/31/96 U12 (8/1/94 to 7/31/95) U13 (8/1/93 to 7/31/94) U14 (8/1/92 to 7/31/93) U15 (8/1/91 to 7/31/92) U16 (8/1/90 to 7/31/91)
*Desired Program:	-CHOOSE- ATP / Challenge Classic / Select
*Home Phone:
*Address:
*City:
*State:
*Zip Code:
*Main eMail:
*School Player Attends:
*Grade in Fall 2006:	-CHOOSE- N/A K 1 2 3 4 5 6 7 8 9 10 11 12
*Skill Level:	-CHOOSE- Beginner Intermediate Advanced
*Current Club Affiliation:
Mother's Information:		Father's Information:
Mother's name:		Father's name:
Home Phone: (if not same as above)		Home Phone: (if not same as above)
Business Phone:		Business Phone:
Mobile Phone: (please list)		Mobile Phone: (please list)
Occupation: (optional)		Occupation: (optional)
*Volunteer:	--CHOOSE-- Coach Assistant Coach Team Manager Landscaping / Mowing Fields Please contact me on other things that may come up I do not wish to volunteer	*Volunteer:	--CHOOSE-- Coach Assistant Coach Team Manager Landscaping / Mowing Fields Please contact me on other things that may come up I do not wish to volunteer
Emergency Information:
*Additional Emergency Contact :
*Phone Number:
Work Number:
Cell Number:
*Primary Care Physician:
*Physician's Phone:
Any allergies/special/important medical information?  Yes  No       If yes, please describe below:              Pediatrician's Name:     Phone:

Note: *You will need your Master Card / Visa / Check Card to continue with pre-registration*