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KCS Soccer player's contact info form


In the interest of being able to contact you in the shortest amount of time possible when needed, please provide the following information.  Your privacy will be respected - none of this information will be accessible by anyone but KCS Soccer coaching staff.

  1. Please provide the following contact information:

          First Name 
           Last Name 
      Street Address 
     Address (cont.) 
                City 
      State/Province 
     Zip/Postal Code 
             Country 
          Home Phone 
              E-mail 
    
  2. Please provide the following:

       Date of Birth 
    
  3. Enter your mother's first name in the space provided below.


  4. Enter your father's first name in the space provided below.


  5. Enter your email address in the space provided below.


  6. Enter your father's email address (only if different from yours) in the space provided below.


  7. Enter your mother's email address (only if different from yours) in the space provided below.


  8. Enter your father's work phone in the space provided below.


  9. Enter your mother's work phone in the space provided below.


  10. Enter your cell phone in the space provided below.


  11. Enter your father's cell phone in the space provided below.


  12. Enter your mother's cell phone in the space provided below.


  13. Enter your pager number in the space provided below.


  14. Enter your father's pager number in the space provided below.


  15. Enter your mother's pager number in the space provided below.



Created by Randy Teachout.
Copyright © 1999 [KCS Soccer Team]. All rights reserved.
Revised: 08/13/05