Player Registration – Kansas United

Player Registrationadmin2017-03-01T06:01:15+00:00

Step 1 of 7 - How Many Players

Player Registration

Please fill out the registration form as complete as possible. If you have any questions or need help, please call Gayla Soyez (316) 640-2816.
How many players are you registering?*

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Player Information
Player Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Select Appropriate Club:
- Kansas United Girls
- Kansas United Boys
Current Grade*

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Player 2 Information
Player Name (P2)*
First Last
Date of Birth (P2)*
MM slash DD slash YYYY
Select Appropriate Club:
- Kansas United Girls
- Kansas United Boys
Current Grade (P2)*

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Player 3 Information
Player Name (P3)*
First Last
Date of Birth (P3)*
MM slash DD slash YYYY
Select Appropriate Club:
- Kansas United Girls
- Kansas United Boys
Current Grade (P3)*

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Parent / Guardian Information
Player(s) lives with?*
Address*
Street Address Address Line 2 City State ZIP Code
Mother's Information
Mother's Name*
First Last
Mother's Email*
Mother's Mobile Phone*
Father's Information
Father's Name*
First Last
Father's Email*
Father's Mobile Phone*
Guardian's Information
Guardian*
First Last
Guardian's Email*
Guardian's Mobile Phone*

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Emergency Information
Emergency Contact*
First Last
Relationship to Player
Emergency Phone*
Medical Insurance Carrier
Policy Number
Physician
First Last
Physician's Phone
Medical Conditions

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Payment
Method of Payment*
Transaction Fee
Price: $0.00
Total
$0.00
Send Check To:

1513 N. McRae Dr.

Goddard, KS 67052
Email Receipt To:
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

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