Gender*
Player Name*
Player School*
Player Grade*
Player D/O/B*
Player Shirt Size*
Parent / Guardian Name*
Parent / Guardian Telephone *
Parent / Guardian E-Mail*
Player Insurance Provider / Policy
COVID-19 (no liability on Penn Playmakers / Facility) *
REGISTER BEFORE TUESDAY NOVEMBER 1ST 2022
ADAMSTOWN YMCA
71 E MAIN ST
ADAMSTOWN, PA 19501
REGISTRATION IS NOT COMPLETE UNTIL $85 FEE IS PAID
NO REFUNDS
No product
