Participant Information

Please fill out this short registration form in order for us to contact you regarding the best way to proceed.

Please note that this form is to register interest in playing for Inter CT in Litchfield as part of Litchfield Hills Soccer Club.

First Name:*

Middle Name:

Last Name:*

Date of Birth:*

Hometown:*

Gender:*

Male

Female

Unspecified

Athlete Phone:

Athlete Email:

Parent/Guardian First Name:*

Parent/Guardian Last Name:*

Parent/Guardian Cell Phone:*

Parent/Guardian Home Phone:

Parent/Guardian Email:*

Registration Sport:

Sport associated with this registration (do not modify)

Registration Type:

Type of registration (do not modify)

Registrant Type:

Type of registrant (do not modify)

Inter Connecticut FC