TOPSoccer Midwest Showcase Registration

* Player Name

* Parent/Guardian 1

* Parent/Guardian 2

* Address

* City

* State

* Zip

* Home Phone

* Cell Phone

* E-mail

* Gender

Male

Female

* DOB

* T-shirt size:

* Check all that apply:

Intellectual Disability

Emotional Disability

Physical Impairment

* Which activity or activities would your athlete like to participate in?

Skill Stations

Buddy Assisted Games

Competitive Showcase Games (No Buddy Assistance)

If playing as part of a larger team, which team?

Any additional comments regarding athlete's needs

* Indicates Response Required

YS	YM	YL	AS
AM	AL	AXL	AXXL