Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Contact Email

Address

Preferred Language

English

Spanish

Other

Player Information

Player First Name

Player Last Name

Player Date of Birth

Month

Day

Year

Player Gender

Player grade

Has your child participated in Canal FC before?

Yes

No

How many children in your household are currently participating in Canal FC or interested in joining?

What program do you want to register to?

Does your student attend the after school program at the school?

Yes

No

Jersey Size

Short Size

Please note any allergies and/or medications

Financial Aid Questions

Please briefly explain why you are requesting financial aid.

What amount are you able to contribute toward your child’s registration fee each month?

Are you requesting financial aid for more than one child?

Yes

No

If yes, please list the names of the children.

Is there anything else you would like Canal FC to know when reviewing your financial aid request?

I understand that financial aid is limited and based on available funding. I also understand that submitting this application does not guarantee approval. I agree.

I understand that participation in the Canal FC Soccer Clinic involves physical activity and there is a risk of injury. I agree to hold harmless Canal FC, ACCESS U Foundation, and all affiliated members for any injuries sustained by my child during the clinic.

By checking this box, I do also hereby give my permission to Canal FC and ACCESS U Foundation to use any and/or all photographs of myself and/or my children for future agency publications. I understand that my name or my children's names) will not be published at any time in any publications. I give my permission for a photograph of my child to be used for Canal FC and ACCESS U Foundation marketing purposes*

Note: Thank you for submitting your financial aid application. A member of the Canal FC staff will review your request and contact you as soon as possible.

FINANCIAL AID APPLICATION QUESTIONS

Parent/Guardian Information

Player Information

Financial Aid Questions