Mid Del Youth Football Association

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MCYFL - MWC Football Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

* Home Phone:

* Birthdate:

* School:

Gender:

* Grade:

* Last Year Team & Coach:

PARENT/GUARDIAN

* Parent Name:

Parent Name:

EMail:

* Home Phone:

Mother Cell:

Father Cell:

Alternate Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Do you have insurance? Check if yes.

* Does Your Child Receive Free or Reduced Lunch?:

Yes

WAIVER INFORMATION

I/we, the parent or guardian, of the above named participate hereby give approval for participation in any and all of the activities of the MCYFL during the current season. I/we hereby give authorization for any emergency medical treatment of the participant for any injury resulting from any activity of the MCYFL. In case of injury to my child, I/we hereby waive all claims against the MCYFL and MWC Parks & Rec. It is understood that efforts shall be made to contact the undersigned or the other emergency contact person as indicated above prior to rendering treatment of the injured participant.

I/we agree with the above *

* Parent/Guardian Name (print):

Signature:

Date:

* indicates required fields

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MCYFL - MWC Football Registration Form