REGISTRANT : AJAO TEMILOLUWA

GENERAL
Registration Date: Program Name: Registration Status:
07/10/2023 Fall Sports 2023-2024 Completed
Registrant Account Owner: Section Name: Payment Status:
bolajeasy@gmail.com Boys Soccer None
Section Price: Approval:
$ 0.00 Approved

PARTICIPANT INFORMATION
Personal
First Name: Last Name: Birth Date:
Temiloluwa Ajao 12/30/2008
Gender:
Male

Contact
Email: Home Phone: Cell Phone:
ajaoabiola71@gmail.com 4434009329 4434009329

Education
Grade:
9

ADDRESS
Home Address
Address: City: State:
8509 GLEN MICHAEL LN APT 202 RANDALLSTOWN MD
Zip/Postal Code:
21133

PARENT OR GUARDIAN
Parent or Guardian
First Name: Last Name: Relationship:
ISMAIL AJAO Father

Contact
Email: Cell Phone:
Bolajeasy@gmail.com 2029102425

EMERGENCY CONTACTS
Emergency Contact
First Name: Last Name: Cell Phone:
ISMAIL AJAO 2029102425
Relationship:
Father

PHYSICIANS
Primary Care Physician
Physical Upload:
https://app.formreleaf.com/public/media/do
cument/20230191fcb14be2c70e481b9707
6901b59a0c82

INSURANCE
Insurance
Carrier:
Kaiser Permanente

QUESTIONS AND COMMENTS

Head Injury/Concussion
Traumatic Head Injury:
No