Chambersburg Recreation Department Soccer K-1 Roster/residency Form

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CHAMBERSBURG RECREATION DEPARTMENT SOCCER
K-1 ROSTER/RESIDENCY FORM
Coach's Name, Address, and Phone:
Please PRINT Names
Coach's e-mail address: (print clearly) ____________________
Circle Male
Date of
Name
Address
Phone
Grade
Circle Residency
Jersey #
or Female
Birth
1.
M
F
CB GU GR HAM LU LKY OTR
2.
CB GU GR HAM LU LKY OTR
M
F
3.
CB GU GR HAM LU LKY OTR
M
F
4.
M
F
CB GU GR HAM LU LKY OTR
5.
M
F
CB GU GR HAM LU LKY OTR
6.
CB GU GR HAM LU LKY OTR
M
F
7.
M
F
CB GU GR HAM LU LKY OTR
8.
M
F
CB GU GR HAM LU LKY OTR
Please list Coordinator, Athletic Director, or PTA/PTO President and a phone number:
*** Date of Birth is not required for programs with no age requirements.
*** As the person responsible for the team, I verify that the above information is correct to the best of my knowledge. I read and understand the
principles of S.C.O.R.E. and pledge to adhere to the standards set forth by the Recreation Department thus helping to provide a great sports experience
for all children.
Team Name: __________________________
Date: ________________
Signature: ____________________________
*** Code for Township/Residency: CB-Chambersburg Borough; GU-Guilford; GR-Greene; HAM-Hamilton; LU-Lurgan; LKY-Letterkenny; O-Other

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