Online Team Registration

1. Volunteer Coach Contact Information

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

2. Please identify Participant One:

First Name
Last Name
Age
Sex	Male Female

3. Please identify Participant Two:

First Name
Last Name
Age
Sex	Male Female

4. Please identify Participant Three:

Name
Age
Sex	Male Female

5. Please identify participant four:

Name
Age
Sex	Male Female

6. Please identify participant five:

Name
Age
Sex	Male Female

7. Please identify Participant Six:

Name
Age
Sex	Male Female

8. Please identify Participant Seven:

Name
Age
Sex	Male Female

9. Please identify Participant Eight:

Name
Age
Sex	Male Female

10. Please identify Participant Nine:

Name
Age
Sex	Male Female

11. Please identify Participant Ten:

Name
Age
Sex	Male Female

12. Please identify the gender of the Team:

Boys Girls

13. Please select the Sport:

1st Grade Basketball
2nd Grade Basketball
Kindergarten & 1st Grade Soccer
2nd and 3rd grades Soccer
4th and 5th grade soccer
AAU Basketball
Lacrosse
Field Hockey
Touch Football

14. Please provide any requests?

15. Have you received written consents from parents?

My Team Members are covered by medical insurance and any special medical conditions will be stated. The Organizers and their representatives are not responsible for any injury or damage that may occur during practices or games. I authorize session staff to act on my behalf in emergency. I agree to MSA’s- No refunds policy which states that only an MSA credit will be issued for future MSA activities