USA ELITE SCOUT TEAM

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PLAYER INFORMATION

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* Last Name:

* Street:

* City:

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* Zip Code:

Home Phone:

Gender:

* Grad Year:

* Jersey Size and number prefered:

* Primary Position:

* Secondary Position:

Height and Weight:

PARENT/GUARDIAN #1

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* Lastname:

* EMail:

Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION:

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