NYFilsa

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Adults 7v7 Outdoor Registration

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

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

NYFilsa/ Club Deportivo el Barrio is not responsible for any player, play at your own risk. By registering you also agree to NYFilsa/ Club Deportivo el Barrio to record game footage and Distribute to social Media, you are allowed to receive the footage also if requested.

I/we agree with the above *

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Adults 7v7 Outdoor Registration