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Region 58
Van Nuys / Sherman Oaks

 Registration Wait-List:


The following information will be emailed to the Registrar to help us maintain a Wait List for filling spots on teams when players drop:

Player First Name: * Player Last Name: *
Date of Birth (mm/dd/yyyy, e.g., 03/01/2001): *

Gender: *
     Boy
     Girl
Played Region 58 last season: *
     Yes
     No

Parent(s) First Name: * Parent(s) Last Name: *
Your Email: *

Your Phone No: *

Cell/Alternate Phone No:


Interested in Coaching:
     Yes
     No
Interested in Refereeing:
     Yes
     No

What type of volunteer work will you be interested in doing? Ideas?

                              Note: Priority will be given to parents who volunteer.

Comments:


                               

* Required field.

 

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