First                                                                 Last

*Player Name:   

*Date of Birth: (mm/dd/yyy)

*Fall 2010 League Age: 9U 10U

                                    First                                                                 Last

*Parent Name:   

* Home Phone:   Cell Phone:

                                   Street                                                      City                                 State                 Zip

*Home Address:                        

*Contact Email:    

Intially, the program is only open for current CBC players. If there are slots open after 7/15/10 it will be opened up on a first come first serve basis.

Comments to CBC :

 * Required fields