Today's Date

PLAYER INFORMATION

Player's Name*

Click the "+" to add more names.

First Name	Last Name	Birthdate

Primary Contact*

Please list primary contact, can be father only, mother only, or both father and mother. Note that whoever is listed must also sign the form.

Mother
Father
Guardian

Primary Contact Name*

First Last Please indicate which parent

Secondary Contact Name

First Last Please indicate which parent

Address*

Street Address City State ZIP Code

Primary Contact Email*

Enter Email Confirm Email

Secondary Contact Email

Enter Email Confirm Email

Primary Contact Phone*

Secondary Contact Phone

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Father/Guardian Name

First Last

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Father/Guardian Address

If different than listed Mother/Guardian

Street Address City State ZIP Code

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Father/Guardian Email

Enter Email Confirm Email

This field is hidden when viewing the form

Father/Guardian Contact Phone

ASSESSMENT OF NEED

Indicate the amount you are able to contribute to the TOTAL cost of your player(s)’s Club Registration Fee.

Age Group: U5-U6 Early Bird fee = $175

Age Group: U7 Early Bird fee = $350

Age Group: U8 Early Bird fee = $400

Age Group: U9-U12 Early Bird fee = $425

Age Group: U14-U19 Early Bird fee = $450

Please state your reason(s) for requesting a Club Registration Fee Waiver:*

How many years has your daughter played for RAGE?*

Please enter a number less than or equal to 20.

Have you been an active volunteer for the RAGE community (i.e. Board Member, Rec Age Group Coordinator, Coach, College Showcase Tournament Support, Referee?*

Yes
No

Please explain your volunteer experience with RAGE:*

How would you like to get involved?*

If your request is approved, you, or one of your immediate family members must volunteer a minimum of 4 hours per season. In which position(s) are you committed to help?*

Please list how you will help:*

Mother/Guardian Signature*

Please sign to complete your application.

Father*

Name

This field is for validation purposes and should be left unchanged.

Club Registration Fee Waiver Request Form

Club Registration Fee Waiver Request Form - Rec Only

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