Players Full Name       

Parents Full Name      

Parents Cell #             

Child's Age as of June 1st this year:

Child's Birth date

Assume that we don't know anything about your child.  Explain in the box below why you are requesting that your child be placed in an age division other than the one her or she would normally be assigned to (according to their age).  Parents preference will not be considered.  Only health, physical maturity, physical or mental disabilities can be considered.