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Player First Name

Player Last Name

Parent or Guardian Name

Phone

Player's DOB

Street Address

Street Address 2

City

Region/State/Province

Postal / Zip code

What date would you like to start your first private lesson?

Child's School Name

For which soccer clinics would you liketo register? Chooe all that apply.

Shooting Skills Clinic

Dribbling Clinic

Name of Neighborhood Group

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CARROLL SPORTS ACADEMIES

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