Marshall Lil Mavs Youth Football & Cheer

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PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

City:

State:

Zip Code:

* Home Phone:

* Birthdate:

* Email:

* Gender:

* Grade:

Firstname:

PARENT/GUARDIAN #1

* 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 *

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Flag Football($50)

Tackle Football($100)

Cheerleading($125)

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