| Child's Name (first & last) |
|
| Address |
|
| City |
|
| Zip |
|
| Date of Birth |
|
| Gender |
Male Female |
|
|
| Parent/Guardian Name |
|
| Relationship (mother, father, uncle, etc.) |
|
| Home Phone |
|
| Work Phone & Extension |
|
| Cell Phone |
|
| Email |
|
| County of Residence |
|
|
|
| Athlete Information |
Students from a non-WPCA school must complete a CYO Eligibility Request (approved by their pastor) |
| Grade |
|
| Religion |
Catholic Other |
| Race |
|
Eligibility
(Non-Catholic school students
must be attending PSR) |
Member of Annunciation / Ascension / St. Pat's
Enrolled at WPCA
Other (requires Eligibility Request Form) |
| School |
|
| Parish |
|
|
|
| Sport Child is Registering for |
(choose ONLY ONE) |
|
Register ONLY for the current season. |
| Fall Sports |
|
| Winter Sports |
|
| Spring Sports |
|
|
|
|
|