______________________ Full Time Program Soccer Camps Latest Headlines Testimonials Photo Gallery Events ______________________ Full-Time Renewal Registration Form Please complete this registration form in full. All fields marked with * are required.Player Information First and Last Name:*FirstLast Gender:*Select valueMaleFemale Date of Birth:*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Primary Phone Number:* If we need to reach you by phone on a training day, the best number to leave a message would be: * Address:* Street Address City State / Province / Region Postal / Zip Code Email (IMPORTANT: this address will be used for all communications such as memos & training changes. Please make sure the e-mail address below is checked on a regular basis):* Second Email (Please provide a second email ONLY if you absolutely MUST have information sent to more than one person):Parent/Guardian Information Name of Parent 1:* Cell Phone Number - Parent 1:* Business or Home Phone Number - Parent 1: Name of Parent 2: Cell Phone Number - Parent 2: Business or Home Phone Number - Parent 2: Emergency Contact Name:* Emergency Phone Number:* If you require a tax receipt for your training, who do we make the tax receipt out to? Who would you like for us to e-mail the tax receipt to?Additional Information Name of Current Soccer Club: Name of Current Soccer League: Will you need a new track suit for next season? ($108/$115)*Select valueYes, Youth ($108)Yes, Adult ($115)No Would you like to order an additional pair of socks for next season ($10/pair)*Select valueYesNo Would you like to order a new Tulis Bag ($30)*Select valueYesNo Would you be interested in purchasing a rain jacket ($70)*Select valueYesNo Notes:Liability Waiver By indicating your acceptance you acknowledge the above-named registrant and the parents/guardians hereby agree that the European Soccer School of Excellence will not be held responsible for any accident or loss no matter how it is caused, and agree to release all instructors, staff or sponsors from all claims or damages which may arise as a result of/or by reason of such accident or loss.*I agree with the above statementImage Rights Waiver By indicating your acceptance you understand and agree that the Roman Tulis staff may take photographic or video images of the above-named registrant. You further grant the Roman Tulis School the right to use such image or likeness in all forms and media, in connection with promotion of our program, or the sport of soccer generally.*I agree with the above statementI do not agree with the above statement IMPORTANT: Before submitting this form, please verify that all information provided is correct and up-to-date.*I confirm that all entries on this form are correctSubmitReset