THUSC Tryouts Pre-Registration

2001 Tryout Pre-Registration

Completely fill in the blanks below and click "register". For security reasons, you will not be permitted to edit your information after you click "register" so please make sure that the information you've entered is exactly correct!

Privacy Statement: THUSC will not sell or otherwise distribute any information collected on this application form to any third party other than the Oregon Youth Soccer Association for any purpose whatsoever. All information collected is to be used only for THUSC's processing of player registrations or to provide information to you about THUSC. Contact the with any questions regarding this privacy policy.

Player Information
First Name		(Required)
Last Name		(Required)
Middle Name
Birth Date (mm/dd/yyyy)		(Required)
Male/Female		(Required)
Address		(Required)
City		(Required)
State		(Required)
Zip Code		(Required)
Phone Number		(Required)
Contact Email Address		(Required)
Family Information
Mother's Name
Mother's Home Phone
Mother's Work Phone
Mother's Employer
Father's Name
Father's Home Phone
Father's Work Phone
Father's Employer
Emergency Contact Information
Alternate Person to Contact in Case of Emergency		(Required)
Phone		(Required)
Relationship to Player
Player's Health Insurance Carrier
Policy Number
Doctor's Name
Doctor's Phone Number
List any medical conditions and/or medication for the player
	CANCEL

Verify that ALL information is correct before clicking "Register".