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de Boot Room Academy Registration

Please use this form to register for de Boot Room Academy.
*Indicates a required field.

*Full Name:
*Address:

*Phone:
*Contact Email:
*Date of Birth:
*Name of Parent or
  Guardian:
*Name of School you are
  currently attending:
*Football experience:

Other relevant experience:

Other information:
(e.g. Medical Conditions, Special Needs, etc.)

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