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Mt Pleasant Location

Athlete First Name *

Athlete Last Name *

Athlete Phone *

Athlete Email *

Athlete Date of Birth *

Parent / Guardian First Name *

Parent / Guardian Phone Number *

Parent / Guardian Email *

Street Address

City

State

What School do you Attend? *

List the Sport(s) you Play *

Referred by *

Waiver and Release, Assumption of Risk Agreement and Parental Indemnification Agreement *

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