Mail
to: Coach Gordon Wetmore SM West High School
8800 W. 85th St.
Overland Park,
KS 66212
(913) 993-7942 e-mail: gordonwetmore@smsd.org
Fax: (913) 993-8099 Hotline 993-8070 then 1-252
S.M. West Vikings Boys Soccer Registration
(Please fill in completely and clearly)
Student Number: ___ ___ ___ ___ ___ ___ ___
Today’s Date: ___/___/___
Name (last, first): _________________________________________________________________
Birth Date: ___/___/___
Fall ’13 Grade: _____
Year of Graduation: ______
Telephone number: (H) __ __ __ - __ __ __ __
(W) __ __
__ - __ __ __ __
Parent Cell __
__ __ - __ __ __ __
Student Cell __ __ __ - __ __ __ __
Parent E-Mail address: ______________________________________________________________
Student E-Mail address: ______________________________________________________________
Street Address: ____________________________________________________________________
_____________________________________ Zip Code: ___
___ ___ ___ ___
Height: ________________
Weight: ______________ Soccer
Position: __________
Other sports participating in or planning to participate in at West:
Winter Sport: ___________________________ Spring
Sport: ________________________
Name of parent/guardian: _______________________________________________________
Telephone number of parent/guardian: (H) __ __ __ - __ __ __ __
(W) __ __ __ - __ __ __ __
Who to contact in case of emergency:
Name: ________________________________ Relationship: ___________________________
Telephone number: __ __ __ - __ __ __ __
Do you have any medical conditions/concerns that the school/coaching staff should be aware of?
Yes ___ No ___ If
yes, please explain: _______________________________________________
_________________________________________________________________________________
__________________________________________________________________________________
