2024 Dillsburg Dual Shootout Application Form

Team Name

Team name is required.

Age Group

Please Select

Age group is required.

Gender

Please Select

Gender is required.

New/First Year Team.

Record Last Season (Required unless new team)

Wins

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Losses

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Ties

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State Association

Please Select

State association is required.

League

Please Select

League is required.

Club

Club is required.

Level of Play: What level of soccer are your currently playing? Premier, D1, D2, or D3 (Premier being most competitive)

Please Select

Level of play is required.

My team is willing to play in the next higher age group if necessary.

Please Select

Willingness to play up is required.

Team Contact Name

Contact name is required.

Street Address

Street address is required.

City

City is required.

State

State is required.

Zip

Zip is required.

Manager's Email

Manager email is required.

Coach's Email

Coach's email is required.

Coach's Mobile Phone

Phone is required.

I certify that during all DDSO tournament games, I will be in possession of a medical release form for all my rostered and guest players. Each form will be signed by the player's parent and/or guardian. I will have medical release forms in my possession throughout the entire tournament.

You must agree to the waiver to continue.