Upward Registration

Upward Registration:

Welcome to Upward! Please fill in all the required information below so that we can properly register your child for our upcoming Upward event.

* = Required Field

Child's Last Name:*
Child's First Name:*
Street Address:*
City:*
State:*
Zip Code:*
Home Phone:*
Parent's Cell Phone:*
Email Address:*
Re-enter Email:*
Church (If you regularly attend church, which one?):
Child's Gender:*
Child's Grade:*
Child's Date Of Birth:*
Years Experience Playing Organized Soccer:*	None 1 2 3 4 5
Is There A Day Your Child Cannot Practice?	Monday Tuesday
Parent/Guardian (1) Information: Parent/Guardian First Name:*
Parent/Guardian Last Name:*
Relationship To Player:*
I Can Support The League As:	Referee Coach Asst Coach Volunteer
Parent/Guardian (2) Information: (Optional): Parent/Guardian First Name:
Parent/Guardian Last Name:
Relationship To Player:
Home Phone:
I Can Support The League As:	Referee Coach Asst. Coach Volunteer
Emergency Contact Information: Emergency Contact First Name:*
Emergency Contact Last Name:*
Emergency Contact Home Phone:*
Emergency Contact Work Phone:*
Emergency Contact Cell Phone:

Place Here Any Additional Player Information Notes For Registration:
Carpool/Coach Link - Please enter Carpool Child's Name/Coach's Name:
Child's Shirt Size:
Child's Short Size: (shorts are optional for an additional $13)
Liability Waiver Release Statement:*	I Have Read And Accept The Liability Release Agreement: Yes No
Please Download and Read Carefully→	Upward Liability Waiver
Please Read Carefully: Does this child have any disabilities, handicaps or present injuries or limitations, allergies, hemophilia, heart conditions, history of respiratory illness, or any other significant medical condition?*	Yes No
If Above Answer Is Yes, Please Explain Here:

Please drop off registration fee by the church office Monday through Friday, between 9:00 am and 5:00 pm.