Registration

ANNAPOLIS SELECT FC ID CLINIC REGISTRATION 2024/25

2017/18 COED
2015/16 Girls
2015 Boys
2014 Boys
2013 Girls
2013 Boys
2011/12 Boys
2010 Boys *(High School Age Team Starting in November After High School Season Ends)


Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info (Not Contact #1 or #2)
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
COVID-19 Liability Waiver
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I've read the above and agree.
 
Assumption of Risk
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I've read the above and agree.
 
Release & Waiver of Liability
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I've read the above and agree.
 
Minor Release
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I've read the above and agree.
 
Medical Emergencies
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I've read the above and agree.
 
Refund Policy
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I've read the above and agree.
 
Electronic Signature
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number:  
Name as it appears on card:
Nickname:
Card Expiration Month:   Exp Year:
Address Line 1: Address Line 2:
City: State: Zip:
 
 
eCheck/Bank Draft:
Bank Name:
Bank Routing Number: (9-digit number)
Your Account Name: (Your name on your bank statement)
Your Account Type:   Account Number: