Admission Form – Divinity Soccer Academy Divinity Soccer Academy ->DIVINITY SOCCER ACADEMY Welcome to the Divinity Soccer Academy (DSA) REGISTRATION page. Please use this form to register your player. Our projected season runs around this schedule: Summer: June 22 – Sept 23rd | Fall: Oct 02 – December 2nd | Winter: Dec 07 – March 15 | Spring: March 29th – June 10 Registration - $175 per childMonthly payment - $140 per child Jersey Set - $35 (Includes: Top, Pants & Socks ) I HAVE READ, UNDERSTOOD AND ACCEPT ALL Terms and ConditionsAccept->PLAYER INFORMATIONFirst Name *Last NameDate of Birth *Gender *BoyGirl->Field/Soccer Related Information 3 QuestionsReason for joining the DSA *Soccer Career DevelopmentLeisure and FitnessBehavior Change ManagementOtherOtherPreferred Soccer Position *ForwardMidfielderDefenderGoalkeeperOtherOtherJersey Size *3XS2XSXSSMLXLOtherOther->Player's Medical History 8 QuestionsVaccination – is the trainee immunization up-to-date? *YesNoPlease provide reason for the vaccination issueIllnesses – has the trainee had the following illnesses *Chicken PoxWhooping CoughScarlet FeverMeaslesMumpsAsthmaPharyngitisEar infectionsOtherPlease select all that applyOther20 Physical Test/Examination – Has the trainee done a physical medical examination? *YesNoRecommendations – is the trainee under medical treatment? *YesNoDietary Limitations – Does the trainee have dietary limitations? *YesNoWhich ones? *VegetarianNo porkNo SugarNo SaltOtherOther->Parent/Guardian This section requires the information of an adult registering the player or child 6 QuestionsPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Last Name *Street Address *Apartment, suite, etc *City *State/Province *ZIP / Postal Code *Phone Number *0 / 10Email Address *Relationship to the trainee *FatherMotherSisterBrotherUncleAuntLegal GuardianOtherOtherIs the responsible adult the same as the emergency contact? *YesNoOtherUpload fileChoose FileNo file chosenDelete uploaded filePICTURE OF YOUR PLAYERSend Message
