Child's Name:

Age:

D.O.B (00/00/0000):

Address:

City:

State:

Zip:

Home Phone (305-555-5555):

School:

Grade:

Mothers Name:

Fathers Name:

Parent's Cell # (305-555-5555):

Email:

Work # (305-555-5555):

Child's Cell # (if of age) (305-555-5555):

I played for MDI Sports last season and my team's name was:

I currently play for my School's team:

Yes If Yes, Position:
No

Uniform Size:

Top: Bottom:

Become a Volunteer for MDI Sports and receive $10.00 off of your child's registration.

Volunteer Information:

Name of Volunteer:

Head Coach:	Assistant coach:	Stats or Score Keeper:
Shirt Size:

Please list information of a contact besides the parents or guardians:

Name:		Relation:
Phone Number (305-555-5555):		Cell Number (305-555-5555):

Sport:

Yes, please add a(n) practice t-shirt for an additional $9.00

Payment and Registration Completion:

Credit Card Information

Credit Card Number:

Expiration Date:

First Name:

Last Name:

Billing Address:

Billing City:

Billing State:

Billing Zip:

Select Payment Type

	PAID IN FULL
	INSTALLMENT OPTION 1 Billed on the 1st of the month
	INSTALLMENT OPTION 2 Billed on the 15th of each month

Explanation Of Charges
Please select a sport to enable payment processing