Registration Form – Jefferson Boys Soccer

Jefferson Boys Soccer

Booster Club Registration

Please complete and submit the following form. Remember to submit payment at the address listed at the bottom of the form.

Booster Club Registration

Player Information

Player Name

Player Email

Grade for 2022-2023 School Year

Player Address

Address Line 1

Address Line 2

City

State

Zip Code

Player Phone Number

Parent/Guardian 1 Information

Parent/Guardian 1 Name

Parent/Guardian 1 Email

Parent/Guardian 1 Address (if different from player)

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian 1 Phone Number

Parent/Guardian 2 Information

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Address (if different from player & parent/guardian 1)

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian 2 Phone

Registration Fees

Which registration option is applicable?

Booster Club Registration Fee $170

Free/reduced lunch Booster Club Fee $0

Please mail your registration fee to:

Andrea Prosser
5140 W. 102nd St. #202
Bloomington, MN 55437