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North Brunswick Soccer Club

Buddy Ball Division

Fall 2021 Registration Form


Email to:  


Opening Day is Saturday, September 11, 2021 @ 10:00 a.m.



Child’s Name (Player)_____________________________________________________


Address:  _______________________________________________________________

        Street                                                City State Zip


Home Phone:  _____________________    Date of Birth ___/___/___  Gender __M __F


Dad’s Name:  ______________________  Mom’s Name: ________________________


Child’s Shirt Size: (circle one)  Child    Sm   Med Large   or Adult    Sm  Med Large


Email Address:  __________________________________________________________


Emergency Information


Doctor’s Name:  _____________________________  Doctor’s Phone: ______________


Emergency Contact & Phone:  _______________________________________________


Parent/Guardian Signature:       _______________________________________________


Please indicate your child’s special needs and any information we may need to know to provide

him/her with a good opportunity and experience:  _____________________________________