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North Brunswick Soccer Club

Buddy Ball Division

Fall 2017 Registration Form

Please click HERE for printer friendly version 

Mail to:  North Brunswick Buddy Ball Soccer

c/o Janice Geiger

923 Kearney Drive, North Brunswick, NJ  08902

Opening Day is Saturday, September 16, 2017 @ 10:30 a.m.

 

Child’s Name __________________________________________________________________________________

 

Address: _____________________________________________________________________________________

                        Street                                                City                         State          Zip

 

Home Phone:  _______________________________    Date of Birth  ___/___/___  Gender __M __F

 

Dad’s Name:  ________________________________  Mom’s Name: _____________________________________

 

Child’s Shirt Size: (circle one)  Child    Sm   Med   Large   or   Adult    Sm    Med    Large

 

Email Address:  ______________________________________________________________________

 

Emergency Information

 

Doctor’s Name:  ____________________________________  Doctor’s Phone: _____________________________

 

Emergency Contact & Phone: _____________________________________________________________________

 

 

Parent/Guardian Signature:       __________________________________________________________

 

 

Please indicate your child’s special needs and any information we may need to know to
provide him/her with a good opportunity and experience: 

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

Notes: