Register Your Child - Phoenix Soccer Academ

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Student Information – Step 1 of 5

Student's Full Name

First

Last

Date of Birth

Gender

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Number

Email Address

Parent/Guardian Full Name

First

Last

Relationship to Student

Contact Number

Email Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country