Last Updated: April 14, 2014 

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2014 Next Level - NFL Flag Football Registration

! Indicates required information

PARTICIPANT INFORMATION
 ! First Name:
 ! Last Name:
Street:
City:
State:
Zip Code:
 ! Phone Number:
Birthdate:
 ! Email:
Gender:
Grade:
T-Shirt Size:
Are You Joining as Part of a TEAM or as an INDIVIDUAL?:
(If an indivdual) 2 friends you would like to have on your team
(If part of a team) Coach's Name - Team

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:
Insurance Carrier:
Policy #:

How did you hear about us?:
   Are You Willing to Help Out as a Coach, Referee, Team Parent, or Volunter  

WAIVER INFORMATION
Parent Release, Medical Treatment, and Authorization:
By sending in this application, I hereby authorize the staff of Next Level FCA to act for me according to their best judgment in any emergency requiring medical attention. I the parent/legal guardian acknowledge that participation in these camps, as in any sport, may result in accidents and/or injuries. Even though there are risks involved, I give my permission for the camper named on this form to participate in any and all camp activities. I expressly assume all risks and hazards incidental to such participation, and I do hereby waive, release, absolve, indemnify, and agree to hold harmless NEXT LEVEL FCA, its staff, suppliers, sponsors, participants, and San Rafael High School for any claim arising out of injury or illness to the said camper, regardless of cause.
   I/we agree with the above  

! Indicates required information



Please Select Season of Registration:
Note: Credit Card information can be entered once this form is complete.
We accept the following credit cards


   




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