Registration Form & Payment | California Republic Soccer Club

PLAYER APPLICATION

Athlete First name

Athlete Last name

Birthday

Month

Day

Year

Gender

Primary Email

Parents Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Position

Preferred Jersey Number

Will your athlete be traveling with a parent?

Yes

If YES, how many people in your party not including the athlete?

Please list any medical issues we should be aware of

Will your child need any medication administered to them?

Passport

Birth Certificate of Athlete

Signature

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Please Sign that you have read and agree to our terms and conditions

Athlete Registration Fee

Initial Registration Deposit$500

Pay in Full $3,495

1/2 payment$1,747.50

A $500 registration deposit is required for everyone in your party traveling with the team.

PAYMENTS ARE NON-REFUNDABLE