GAM United Youth Academy Registration – GAM UNITED FC & YOUTH ACADEMY

Player Full Name

Please enter the player’s full name.

This field is required.

Age Group

Select the player’s age group.

Gender

Select the player’s gender.

School Name

Please enter the school name.

This field is required.

Parent/Guardian Full Name

Please enter the full name of the parent or guardian.

This field is required.

Email Address

Please enter a valid email address.

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Phone Number

Please enter a contact number for the parent or guardian.

This field is required.

Home Address

Please enter the full home address.

Address Line 1

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Address Line 2

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City

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State

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Postal Code

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Country

Emergency Contact Name

Please enter the name of the emergency contact.

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Emergency Contact Relationship

What is your relationship to the emergency contact?

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Emergency Contact Phone Number

Please enter the emergency contact’s phone number.

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Allergies or Medical Conditions

Please list any known allergies or medical conditions.

Doctor’s Name & Contact

Please enter the doctor’s name and contact number.

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Insurance Provider

Please enter the insurance provider name.

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Agreement & Acknowledgments

I understand and agree to GAM United’s code of conduct and policies.

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Consent to Emergency Medical Treatment

I consent to emergency medical treatment if needed.

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Submit

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