CPA - Championship Performance Academy

Who are you registering?
Player Name(s)*
Note: All fields are required, put N/A for Allergies & Medications if not applicable. If you are registering more than one player, click the (+) icon after medical to add fields.
Full name Gender Birthday T-Shirt Size Height Weight Offensive Position Defensive Position School Grade Allergies Other Medical Conditions

Save and Continue Later

Save and Continue Later

Emergency Contact
In an emergency, when parents cannot be reached, please contact:
Primary Emergency Contact's Name*
First Last
Primary Emergency Contact Home/Cell Phone*
Primary Emergency Contact Work Phone
Primary Emergency Contact Relationship to Player*
Secondary Emergency Contact's Name
First Last
Secondary Emergency Contact Home Phone
Secondary Emergency Contact Work Phone
Secondary Emergency Contact Relationship to Player
Insurance Information
If said participant is covered by any insurance company, please complete the following:
Medical Insurance Company*
Medical Insurance Policy Holder*
Medical Insurance Phone Number
Medical Insurance Policy Number*
Medical Insurance Group Number
Physician Information
Physician's Name*
First Last
Hospital of Choice*
Physician’s Work Phone*

Save and Continue Later

Welcome

Full name	Gender	Birthday	T-Shirt Size	Height	Weight	Offensive Position	Defensive Position	School	Grade	Allergies	Other Medical Conditions