EA Columbus Day Soccer Clinic Registration

PARENT INFORMATION

Please complete this registration form to secure your child's enrollment in our EA Columbus Day Soccer Clinic.

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* 1. Parent/Guardian #1 Information

First Name

Last Name

Work Phone

Cell Phone

Email Address

Home Address

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* 2. Parent/Guardian #2 Information

First Name

Last Name

Work Phone

Cell Phone

Email Address

Home Address

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* 3. Is your child currently enrolled at Episcopal Academy?

Yes

No

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* 4. Are you an EA Faculty Member?

Yes

No

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* 5. If yes, please provide your position: