SPRING 2019 Registration

2019 Fall SEASON Postponed

Where: 600 West Montrose Harbor Drive, Chicago, IL 60640 (W Montrose Ave/N Simonds Dr/W Montrose Harbor Dr)
Eligibility: Ages 5-12 (older/younger please inquire)
$125 per child, for 8 sessions

Please complete the form below

(Payment will be requested upon completion of registration)

Athlete Information

$125 per child for 8 sessions

Players Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday

YYYY

Sex

Male

Female

Gender Neutral

Preferred Name

Does your child have a name they prefer to be called by?

Parent / Emergency Information

Are you new to the TOPSoccer Program?

Yes

Parent Name

First Name

Last Name

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Email Address

Verify Email Address

Emergency Contact

(not parent or guardian attending practice)

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Health History

All information listed below is OPTIONAL and NOT required. Please list what would be pertinent to the safety of your child & soccer only. Thank you.

Nature of disability

Special equipment used

wheelchair, walker, et al

Please list any medical issues we need to be aware of

Allergies, asthma, seizures, et al

Please list any behavioral information that may help the coaching staff and buddies

Please give us any suggestions to help our coaches and volunteers make this a successful experience for your child

Medical Release Form (PDF) and Payment will be asked for remittance on registration confirmation page.