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/ Competitive Team – Regular payment ¿Register a sibling? click here
Competitive Team – Regular payment
¿Register a sibling? click here
$
595.00
*
Player's Last Name
$
*
First Name
$
Middle Name
$
*
Address
$
*
City
$
State
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
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Indiana
Iowa
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
$
*
ZIP code
$
*
Date of Birth
$
*
Gender
FEMALE
MALE
$
*
T-Shirt Size
Youth extra small
Youth small
Youth medium
Youth Large
Youth extra large
Adult small
Adult medium
Adult large
$
*
Name of Emergency Contact #1 (not living with you)
$
*
Phone
$
*
Relationship
$
Name of Emergency Contact #2 (not living with you)
$
Phone
$
Relationship
$
Medical Insurance Company
$
Policy Holder
$
Policy #
$
Group #
$
Player's Physician Name
$
Phone
$
*
Player Allergies?
YES
NO
$
*
Does player require medications?
YES
NO
$
*
Do you allow Atletico de Madrid Academy Miami to call emergency services?
YES
NO
$
Please list allergies and/or medications and/or past injuries
$
*
Please indicate if player has any of these problems
KIDNEY
ASTHMA
DIABETES
OTHERS
NONE
$
List Other Medical Conditions and/or Limitations
$
I accept
Term & conditions
$
— OR —
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Category:
Competitive
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