2024 Dillsburg Dual Shootout Application Form

Team Name

Age Group

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Gender

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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

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League

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Club

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

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

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Team Contact Name

Street Address

City

State

Zip

Manager's Email

Coach's Email

Coach's Mobile Phone

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.