College Church of the Nazarene
Online Registration for Upward Soccer
 

Participant Information
Payment is $80 due on Evaluation Night (payable to College Church)
   
  First Name * MI Last Name *
     
  Address
  City
  State
  Zip
     
  Email
     
  Church
     
  School
       
  Date of Birth * (MM/DD/YY)
       
  Phone number (XXX) XXX-XXXX
       
  Years of Upward experience * Gender * Grade *
             
 
Sizing Information
   
  Jersey Size *  
  Shorts Size  
       
  On a scale of 1-10, how assertive is your child - while playing? (1 = low, 10 = high) *
     
  Evaluation Score Height (in inches) *
         
  If necessary, pick one night that your child cannot practice.
  Please enter the name of a child you wish to carpool with.
     
 
   
  Notes
     
  Emergency Contact First Name Emergency Contact Last Name
         
  Emergency Contact Home Phone
  Emergency Contact Work Phone
     
  Today's Date *    
         
  Sock Size (for soccer only)    
         
 
Parent / Guardian Information
(At Least One is Required)
   
  Parent / Guardian #1      
  First Name *    
  MI    
  Last Name *    
         
  Home Phone   (XXX) XXX-XXXX
  Work Phone Work Extension
  Cell Phone    
         
  Relationship    
         
  Employer Email
         
  Parent / Guardian #2      
  First Name    
  MI    
  Last Name    
         
  Home Phone   (XXX) XXX-XXXX
  Work Phone Work Extension
  Cell Phone    
         
  Relationship    
         
  Employer Email