Participant Information
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth (age calculated based on event date)
*
USAR ID #
*
City/State
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Club/School
*
Please list any medical conditions or allergies
*
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
Parent or Guardian Information
Parent or Guardian Name
*
First Name
Last Name
Parent or Guardian Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent or Guardian Email
*
example@example.com
Registration Acknowledgement
I confirm the details above are accurate and agree to receive clinic communications.
*
Yes
If registering a player under 18, I am their parent or legal guardian and consent to their registration.
*
Yes
I understand NCYRU will confirm my place and provide any required participation forms before the clinic.
*
Yes
My Products
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All Girls Workshop - November 1st Session - Raleigh, NC
$80.00
$
80.00
All Girls Workshop - November 15th Session - Cornelius, NC
$80.00
$
80.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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After submitting the form, you will be redirected to Cash App Pay to complete the payment.
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