Elite Soccer Academy

Parent / Guardian Information

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Email *

Phone *

Child Information

Child's Name *

Date of Birth *

Program Selection

Select a Program *

Medical Information

Allergies, Conditions, or Special Needs (optional)

Emergency Contact

Contact Name *

Contact Phone *

I agree to the terms and waiver. I understand and accept the risks associated with athletic activities and authorize emergency medical treatment if necessary. *

Register Your Child

Parent / Guardian Information

Child Information

Program Selection

Medical Information

Emergency Contact

Program Summary