TRYOUT APPLICATION

$36.40 | Application Fee*

BRAMPTON
U17

*Non-refundable

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Date of Birth:* Date of Birth is Required

Name of School: Name of School is not valid

Primary Guardian Full Name:* Primary Guardian Full Name is Required

Primary Guardian Contact Number:* Primary Guardian Contact Number is Required

Primary Guardian Email Address:* Primary Guardian Email Address is Required

Emergency Contact Full Name: Emergency Contact Full Name is not valid

Emergency Contact Number: Emergency Contact Number is not valid

Doctor to Notify Full Name: Doctor to Notify Full Name is not valid

Doctor to Notify Contact Number: Doctor to Notify Contact Number is not valid

Medical Conditions: Medical Conditions is not valid

Location:* Location is Required

I consent to the medical treatment of a minor:* I consent to the medical treatment of a minor is Required

Yes

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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Tryout Application – Brampton – U17

TRYOUT APPLICATION

$36.40 | Application Fee*

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