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Eastern Carolina Youth Football League
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Eastern Carolina Youth Football League
PLAYER INFORMATION
*
First Name:
*
Last Name:
*
Street:
*
City:
*
State:
*
Zip Code:
*
Home Phone:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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23
24
25
26
27
28
29
30
31
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Email:
*
Gender:
M
F
*
Grade:
K
1
2
3
4
5
6
7
8
9
10
11
12
PARENT/GUARDIAN #1
*
Firstname:
*
Lastname:
EMail:
*
Home Phone:
*
Work Phone:
*
Cell Phone:
PARENT/GUARDIAN #2
*
Firstname:
*
Lastname:
*
Email:
*
Home Phone:
*
Work Phone:
*
Cell Phone:
MEDICAL/EMERGENCY CONTACT INFORMATION
*
Emergency Contact:
*
Phone:
*
Relationship to Player:
*
Insurance Carrier:
Policy #:
WAIVER INFORMATION
*** Insert your waiver information here ***
I/we agree with the above
*
* indicates required fields
FLAG: 5-7, 8-10 & 11-13 & 14 (Middle school) Full price($135)
*
FLAG:5-7, 8-10 & 11-13 & 14 (middle school) half price($65.5)
*
COLLEGE 8-10 & PRO 11-13 & 14 (middle school) Full price($165)
*
COLLEGE 8-10 & PRO 11-13 & 14 ( middle school) half price($82.5)
*
CHEERLEADER 5-7, 8-10, 11-13 & 14(middle school) Full price($145)
*
CHEERLEADER 5-7, 8-10, 11-13 & 14(middle school) half price($72.5)
*
REPORTER 5-7, 8-10,11-13 & 14(middle school) Full price($110)
*
REPORTER 5-7, 8-10, 11-13 & 14(middle school) half price($55)
*
TEAM MANAGER & BALL BOY& GIRL, Full price($65)
*
