Belvidere Jr Tackle

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Player Registration

Player Information

* Program:

* First Name:

* Last Name:

* Gender:

* Birthdate (mm/dd/yy):

* School:

Grade (Fall):

Age (as of August 1st 2012):

Comment:

Parent/Guardian (Primary)

* First Name:

* Last Name:

* E-Mail:

* Street Address:

* City:

* State:

* Zip:

* Phone:

* Cell Phone:

Parent/Guardian #2

* Work Phone:

First Name:

Last Name:

E-Mail:

Phone:

Cell Phone:

Work Phone:

Medical/Emergency Contact Information

* Emergency Contact:

* Emergency Phone:

* Relationship to Player:

* Player's Physican:

* Physican Phone Number:

Medical Conditions BJT should be aware of:

* Do you authorize BJT coaches or officials to send you child (properly accompanied) to an available hospital or physician?:

* Did player participate in BJT last year:

If so, what Division/Level:

Siblings in programs:

* Preferred phone number for BJT to call regarding registration, team, game or practice:

We will need a state copy of your child's birth certificate if your child didn't participate in BJT last season.

We will need payment (cash, check or credit card). Please make checks out to BJT.

If Forms submitted on-line with credit card payment - Attend parent meeting to submit state copy of birth certificate if required and sign forms.

If Forms submitted on-line without credit card payment - Attend any of the registration dates to submit payment, submit state copy of birth certificate if required and sign forms. If payment not received by last registration date, then child will be un-enrolled from the program.

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