Team Name:*
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State Association:
|
Club and League:*
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Division or Level of Play:*
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Applying for what age group?
U7
U8
U9
U10
U11
U12
U13
U14
U15
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Gender
Boys
Girls
|
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Primary Contact Title:
Coach
Assistant Coach
Manager
Parent
|
Primary Contact Name:*
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Email Address:*
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Primary Contact Street Address:*
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Primary Contact City:*
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Primary Contact State:*
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Primary Contact Zip Code:*
|
Home Phone:*
|
Cel Phone:
|
Secondary Contact Title:
Coach
Assistant Coach
Manager
Parent
|
Secondary Contact Name:
|
Secondary Email Address:
|
|
League Record Won:*
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League Record Lost:*
|
League Record Tied:*
|
How Many Games Does Your Team Play Annually?:
1 to 20
21 to 40
More than 40
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Competed in State Cup:
Yes
No
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State Cup Place:
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State Cup Won:
|
State Cup Lost:
|
State Cup Tied:
|
Tournaments and Place of Finish in the Last 2 Yrs:*
|
Willing to Sign a Liability Waiver at Check In:
Yes
No
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Name of Person Completing the Application:
|
|
| * Required |
