MOBILE SOCCER CLUB REGISTRATION

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After you have completed this registration form, please print a copy for your records and bring it with you to your child's first Academy Session. Please also remember to mail your payment to Mobile Soccer Club, Inc., P. O. Box 8363, Mobile, Alabama 36689. Please remember to indicate the purpose of your payment in the "Memo" section of the check.

Player Information

First Name:

Last Name:

DOB:

Age:

Gender:

School Attending:

School Grade:

Is your child currently playing in a soccer league?

If so, where?

Address:

City:

State:

Zip:

Phone:

Parental Information

Father's Name:

Father's Email:

Father's Cell

Make Primary Email

You May Text Me

Mother's Name:

Mother's Email:

Mother's Cell

Make Primary Email

You May Text Me

Emergency Contact

Emergency Contact:

Phone:

Significant Medical Conditions

Other Pertinent Information:

T-Shirt / Uniform Size

T-Shirt Size:

Date (MM/DD/YYYY):

Electronic Signature of Parent:

Create A Login Password

Password:

Confirm Pass:

After you click "Register Now", please print a copy of this form and bring it with you to the first Academy Session. Please make your payment to Mobile Soccer Club, Inc., P. O. Box 8363, Mobile, Alabama 36689.

I agree to the terms & conditions