FC Viktoria - 2023 Outdoor U15/U19 Registration

14025 - 142 Street NW, Edmonton Alberta, T6V1H8

Player First Name*

Player Last Name*

Age Group*

Male

Female

Address*

City*

Postal*

Birthdate*

Home Phone*

Email*

Guardian 1

Guardian 1 Cell

Guardian 2 Name

Guardian 2 Cell

Previous Teams Played for

Emergency Contact*

Emergency Contact Phone*

Any known medical conditions

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