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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Primary Phone

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* 5. Secondary Phone

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* 6. Date of Birth (mm/dd/yyy)

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* 7. Address

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* 8. City

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* 9. State

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* 10. Zip Code

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* 11. Gender

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* 12. Home Airport (e.g. Denver International Airport, DIA)

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* 13. Emergency Contact Name

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* 14. Emergency Contact Phone

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* 15. Emergency Contact Relation to Applicant (i.e. mother, spouse, roommate))

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* 16. Are you legally blind? Please choose your visual classification.

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* 17. Please describe any medical conditions we should be aware of, e.g., life threatening food allergies, asthma... If none please put N/A.

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* 18. Describe any experience you have playing blind soccer.

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* 19. Describe your goals for attending this camp.

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* 20. COVID19 Safety Measures:
USABA is committed to keeping all athletes, staff, and volunteers healthy while attending this Blind soccer Camp. In order to do so you are required to provide proof of negative COVID19 PCR test no more than 72 hours prior to travel. Or, if you are fully vaccinated to provide a copy of your vaccine card. More details to be provided as the dates of the camp draw nearer.

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