Mailling Address:
PO Box 15993, Rio Rancho, NM 87174
Phone:
505-892-4652
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Rio Rancho Soccer Club Academy Registration
For children born between Aug 01, 2003 and July 31, 2004
Player’s First Name:
REQUIRED
Player's Last Name:
REQUIRED
Player's Birth Date:
Month
Day
Year
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2003
2004
REQUIRED
Player's Sex:
Male
Female
REQUIRED
Player's Age Group:
U5 8-1-2003 to 7-31-2004
U6 8-1-2002 to 7-31-2003
U7 8-1-2001 to 7-31-2002
U8 8-1-2000 to 7-31-2001
U9 8-1-1999 to 7-31-2000
U10 8-1-1998 to 7-31-1999
U11 8-1-1997 to 7-31-1998
U12 8-1-1996 to 7-31-1997
U13 8-1-1995 to 7-31-1996
U14 8-1-1994 to 7-31-1995
U15 8-1-1993 to 7-31-1994
U16 8-1-1992 to 7-31-1993
U17 8-1-1991 to 7-31-1992
REQUIRED
Player's Jersey Size:
Youth Small
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
REQUIRED
Player's Shorts Size:
Youth Small
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
REQUIRED
Street Address:
REQUIRED
Apt. #:
REQUIRED
City:
REQUIRED
State:
REQUIRED
Zip Code:
REQUIRED
E-mail Address:
REQUIRED
Father’s First Name:
Father's Last Name:
Father’s Home Phone:
Father's Other Phone:
Mother’s First Name:
Mother's Last Name:
Mother’s Home Phone:
Mother's Other Phone:
Emergency Contact:
Emergency Phone:
Emergency other Phone:
Additional Emergency Contact:
Additional Emergency Phone:
Additional Emergency other Phone:
List any medical problem or prohibition player has:
REQUIRED
Allergies:
REQUIRED
Physician:
Physician Phone:
Additional Physician Phone:
Medical/Hospital Insurance Company:
Provider Phone:
Policy Holder's Name:
Policy Number:
