Program Code: Location:  Hamilton Soccer World Players Paradise – Stoney Creek Burloak Sports Centre  

First Name:   Last Name:  Participants Age:

Address:   City: Phone:
                                                                                                                                eg. (123)123-1234
Postal Code:   Childs Date of Birth:

Email: Email Verification:

Guardian(s) Name:   Guardian(s) Phone: eg. (123)123-1234

Emergency Contact Phone: Health Card #:
                                            eg. (123)123-1234
Any Allergies/Illnesses: Yes    No    If Yes Please Describe:

How did you hear about us?