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Last Name

First Name

Parent Email

Parent 1 Mobile

Parent 1 Last Name

Parent 1 First Name

Parent 2 Last Name

Parent 2 First Name

Citizenship

Address 1

Country of Representation

Address 2

City

Zip Code

Home Phone

Parent 2 Mobile

Student Mobile

Student Email

Emergency Contact

Contact Telephone

Student D.O.B.

Gender

School Name

Current Grade

Principal Name

Previous Clubs/Teams

Household Size - # of Adults

Household Size - # of Youth

Do parents or student have outstanding obligations to any previous club, or any outstanding fees, dismissals or suspensions?

If Yes, please provide details:

Registration fee includes membership in the United States Fencing Association*, the national governing body for the sport of fencing in the United States.

adaptive REGISTRATION

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