WNE Women's Soccer Fall Prospect Day

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Name *

Year of Graduation *

Anticipated Major *

Email address *

Hone Address *

City, State, Zip Code *

Emergency Contact Information *

Primary Position *

Secondary Position *

Insurance Provider *

Insurance Policy Number *

Allergies / Medical Conditions *

T-Shirt Size *

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I hereby state my child is in good health. In the event of an emergency, I give permission to WNE Athletic Training/Health Services to properly treat my child. I waive all liability toward WNE Soccer and Western New England University.

Parent Signature *

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