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Youth CO-ED Flag Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Address:

* City:

* Postal Code:

* Home Phone:

* Birthdate:

* Email:

Gender:

* Has your Son or Daughter played for M.I.F.A. before?:

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 abide by the rules, regulation of M.I.F.A. and conduct myself in a sportsmanlike manner during all M.I.F.A. football events. I agree that the player named above will not be permitted to participate in any practices or games until an application form and insurance waiver have been signed, all other documentation has been provided, and the required fees paid. WE DO NOT PROVIDE A REFUND FOR ANY LEAGUE FEES PAID.

I/we agree with the above *

* indicates required fields

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Youth CO-ED Flag Registration