PACC & PSA Registration – Palestino Soccer Academy

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Full Name of Participant *

Date of Birth of Participant *

Gender *MaleFemale

Full Name of Parent/Guardian *

Relationship to Participant *

Contact Number of Parent/Guardian *

Email Address of Parent/Guardian *

Emergency Contact Info

Emergency Contact Phone Number *

Medical Conditions or Allergies *

Upload a Recent Photo of the Participant *(The photo will be used to create an ID for the player.)

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