REGISTRATION

PTR Spring / Summer – Athlete Registration

Athlete Registration

Player Information:

*
First Name
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Last Name
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*
Date of Birth
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Gender
MaleFemale
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*
Phone
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*
Email Address
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*
School / Club
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*
Player Position
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*
T-Shirt Size
XSSMLXLXXL
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Experience
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Parent/Guardian Information:

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Parent First Name
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*
Parent Last Name
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Parent Home Phone
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Parent Cell Phone
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*
Parent E-mail
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*
Emergency Contact Name and Phone number
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Address:

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House number and street name
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Apartment, Suite, Unit, Etc. (optional)
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*
City / Town
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*
Province
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*
Postal Code / ZIP
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*
Country/Region
Country/RegionAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe
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Health History:

Health Card #
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Maximum 12 characters allowed.
Allergies
YesNo
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Asthma / Respiratory concerns
YesNo
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Blackouts / Fainting
YesNo
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Chest Pain
YesNo
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Diabetes
YesNo
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Epilepsy
YesNo
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Hearing Disorder
YesNo
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Heart Condition
YesNo
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Recurring Headaches
YesNo
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Seizures
YesNo
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Glasses
YesNo
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Contact Lenses
YesNo
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Injuries
YesNo
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Medications
YesNo
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Other (including recent surgery)
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Profile Settings:

*
Username
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*
Password
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Please enter at least 6 characters.
    Strength: Very Weak
    Avatar
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    Profile Cover
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