Registration Form

PLAYER INFORMATION
* First Name:
* Last Name:
* Street:
* City:
* Province:
* Postal Code:
* Home Phone:
* Birthdate:
* Email:
Spring Season Play  
Fall Season Play  
* Gender:
* Grade:
* Height:
* Weight:
* Shirt and Short Sizes:
* Position Played:
* Previous Numbers:
PARENT/GUARDIAN #1

* Firstname:
* Lastname:
* Email:
* Home Phone:
* Cell Phone:

PARENT/GUARDIAN #2
* Firstname:
* Lastname:
* Email:
* Home Phone:
* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION
* Emergency Contact:
* Phone:
* Relationship to Player:

WAIVER INFORMATION
PARENTS PERMISSION TO PLAY
1. CONDUCT: I/my participating child hereby agree to abide by and support the current BDFC rules of play and personal conduct.
2. I hereby authorize and permit the above to participate in the activities of this Football Club. Hereby release and absolve the Operators, The City of Brantford, Brant & District Football Club, their Sponsors, their Employees and Agents from any or all responsibility due to any injury or problem that may occur.
3. Further, I permit any member of the BDFC or staff member of the Corporation of The City of Brantford to admit my child listed above to hospital emergency for treatment of injury sustained.
4. All NSF CHEQUES will be subject to a $5.00 NSF charge (per cheque).
5. NO REFUNDS WILL BE ISSUED UNLESS APPROVED BY THE BOARD OF DIRECTORS.
6. All equipment is supplied by BDFC. It remains the property of BDFC and must be returned to BDFC at end of season.
I/we agree with the above   *
You must either pay the full registration fee or $150 to have the form submitted.:

Signature: ___________________________________   Date: ____________________

Signature: ___________________________________   Date: ____________________

* required


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Payments Accepted By

Note: Credit Card information can be entered once this form is submitted


   




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