Child/Player Information: Player 1

* 1. Player's First Name

* 2. Player's Last Name

* 3. Player's Date of Birth (MM/DD/YYYY)

* 4. Player's Gender

* 5. Player's Grade

* 6. Player's Ethnicity

* 7. Player's School Name

* 8. Has your child participated in Soccer for Success before?

* 9. Does your child receive free/reduced price lunch at school during the school year?

* 10. Please list any known allergies/medical conditions

* 11. Is there anything else we should know about your child?

* 12. Please select the site you are registering for

Site Locations

Durant Park
(Durant St., between Houston St. & Koester St. - South Buffalo, 14220)
Houghton Park (Clinton St., next to Houghton Academy - 1725 Clinton St. Buffalo, 14206)

JFK Park (Hickory St., between Clinton St. & S. Division St. - Buffalo, 14204)
JH Williams Park (Seabrook St., off Vulcan St. by Kenmore Ave. - Buffalo, 14207)
Madden Park
(Off Bailey Ave., between Regent St. & Moreland St. - Buffalo, 14206)

Roosevelt Park (Off Suffolk St., between Roosevelt Ave. & Martha Ave. - Buffalo, 14215)
Waterfront Park (Behind PS#95, at Village Ct. & Carolina St. - Buffalo, 14202)

* 13. Please choose a jersey size

* 14. I am only registering one player

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