Player's Name:

E-Mail Address:

Gender:

Male       Female

Birth date:(mm/dd/yy)

Street Address:

City:

State:

Zip Code:

Home Phone (with area code):

Cell Phone (with area code):

Parents Name:

Mom 

Dad  

Please list any other information that you would like our staff to know:

Registration for Team Dayton Juniors is open to everyone

    Your $40.00 Spring program registration fee must be mailed to:

     Make checks payable to Team Dayton (please write in your son or daughters name on the check)

    Team Dayton

     P.O Box 340148

     Beavercreek, Ohio 45434

     Once you have completed the on-line registration form and mailed in your payment a conformation e-mail will be sent to you indicating that your son or daughter is registered for the Team Dayton Juniors spring program