Player Information Form Page 3

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Parent Information
Father or First Guardian Information
Full Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State/Province
ZIP/Postal Code
Phone (Home):
(
)
Phone (Cell):
(
)
Phone (Work):
(
)
E-mail Address:
SSN*:
DOB*:
*SSN and DOB will only be used in case of emergency and supplied to medical personnel to complete admission paperwork.
Mother or Second Guardian Information
Full Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State/Province
ZIP/Postal Code
(
)
(
)
Phone (Home):
Phone (Cell):
Phone (Work):
(
)
E-mail Address:
SSN:
DOB:
*SSN and DOB will only be used in case of emergency and supplied to medical personnel to complete admission paperwork.
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. I also acknowledge and authorize the
release of some or all of this information for the following uses: determination of accuracy by coaches and staff, public
relations and marketing (press releases, press kits, and programs), and other promotional activities as necessary.
Privacy Policy. We will not release any of this information to third parties except as outlined as above. This information
will not be distributed to sponsors nor be used for the purposes of solicitation by the Eugene Generals or any of its
partners, nor released to a third party for such activity.
If this application leads to a signing of a contract with the Eugene Generals, I understand that false or misleading
information in my application or interview may result in my release.
Signature:
Date:
Signature Parent or Guardian:
(if under 18)
Date:
Form Version 1.2 Revised August 4, 2015.
Page 3 of 3

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