Sioux River United Registration

Player’s Name:           Last: First: 

Father’s Name:           Last: First:   

Mother’s Name:          Last: First:   

Player’s Address:

Home Phone Number: Cell Phone Number:

Email Address: Secondary Email Address:

Player’s Date of Birth: Player’s Gender: Male Female

Player’s Grade in School (circle) 4 5 6 7 8 9 10 11 12

Player’s Field Position (circle all that apply)

Defender Midfielder Forward Goalie

Player’s Last Year’s Club team: Name: Age of team (U12, U14, etc)

Coach:

Return Registration form to Vicki Swedlund, SRU Registrar, 1016 Oakwood Circle, Brookings, SD 57006 or via E-mail svswede@brookings.net.