Winner's Edge 2008 - Online Registration
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= Required
PLAYER INFORMATION
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Player First Name:
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Player Last Name:
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Address:
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City:
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Zip Code:
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Current School:
Choose School...
Allderdice
East End
St. Edmund's
Baldwin
Bethel Park
Blackhawk
Butler
Chartiers Valley
Ellis
Erie
Fairmont
Fox Chapel
Franklin Regional
Greensburg Central Catholic
Greensburg Salem
Hampton
Aquinas
Hempfield
Knoch
Latrobe
Valley School
Morgantown
Mt. Lebanon
North Allegheny
North Hills
Oakland Catholic
Peters
Pittsburgh Youth Lacrosse
Pine-Richland
Quaker Valley
Seneca Valley
Seton-LaSalle
Sewickley Academy
Shady Side Academy
Shaler
University
Upper St. Clair
Vincentian
Winchester Thurston
Yough
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Player Home Phone:
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Player Cell Phone:
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Parent Cell Phone:
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Grade in School just Completed:
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11
10
9
8
7
6
5
4
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Date of Birth:
1
2
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5
6
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8
9
10
11
12
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1
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1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
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Years Played:
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0
1
2
3
4
5
6+
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What Position do you Play?
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Attack
Midfield
Defense
Goalie
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Shirt Size:
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Small
Medium
Large
X-Large
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Player's E-Mail:
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Re-Enter E-mail:
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Parent's E-Mail:
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Re-Enter E-mail:
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Coach's Name:
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Coach's E-Mail:
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Re-Enter E-mail:
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Coach's Cell:
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MEDICAL / EMERGENCY INFORMATION
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Do you wear glasses?:
Yes
No
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Do you wear contacts?:
Yes
No
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Do you have a hearing aid(s)?:
Yes
No
Other? Please explain:
Please explain any medical condition that would affect your ability to participate safely:
If you have any allergies or special health needs, please explain:
If you use an inhaler or any other medication, please explain:
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Date of last tetanus booster:
1
2
3
4
5
6
7
8
9
10
11
12
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1
2
3
4
5
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11
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20
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24
25
26
27
28
29
30
31
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1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
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Player's Doctor:
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Doctor's Phone Number:
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HEALTH INSURANCE INFORMATION
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Health Insurance Company:
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Policy Number:
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Group Number:
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Insurance Phone Number:
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EMERGENCY CONTACT INFORMATION
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Emergency Contact Name:
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Relationship:
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Emergency Phone Number:
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Emergency Cell Phone Number:
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