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Uptown Soccer Sign Up 2019/20
Register to join our programs for 2019 / 20 / Inscribir aqui para nuestras programas 2019 / 20
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* Indicates required question
Child's First Name / Nombre de niño
*
Your answer
Child's Last Name / Apellido del niño
*
Your answer
Age / Edad
*
Your answer
Date of Birth / Fecha de nacimiento
*
MM
/
DD
/
YYYY
Address / Direccion
*
Your answer
City / Ciudad
*
New York
Bronx
Other:
Zip Code /
*
Your answer
Cel Phone No / Numero de telefono
*
Your answer
Email
*
Your answer
Name of Parent / Nombre de Padre
*
Your answer
Alternative Phone no. / Numero telefono alternativo
*
Your answer
Gender of Child
Female
Male
Clear selection
Ethnicity
Latino
White
African American
Mixed Race
Asian
Other:
Clear selection
Does your child receive free lunch at school / Recibe almuerzo gratis en escuela?
Yes
No
Clear selection
Any Health / Medical concerns we should be aware of? / Algunas condiciones medicas?
*
Your answer
Liability Waiver
*
I have read and agree to the Liability Waiver: Here:
http://goo.gl/hLOLX
Required
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