Cap City Falcons Athletic Association

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REGISTRATION FOR 2019

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:

WAIVER INFORMATION

I agree to pay the full registration fee that is due in order for my child to participate. I also understand that the registration fee includes a $30 non-refundable deposit for all sports I register to participate in. I also agree to adhere to all rules in the Cap City Bylaws and Code of Conduct. Should I be found in non-compliance of any rule listed herein, I understand that I can be dismissed without refund from the organization.

I/we agree with the above *

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REGISTRATION FOR 2019