Wylie Competitive Youth Football Association

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2015 Football Player Registration

* Age Division:

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

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 #:

WAIVER INFORMATION

I understand and recognize the risk of physical injury inherent in football and I am willing to assume those risks. I agree that I will not hold Wylie Competitive Youth Football Association, the organizers or any of its coaches liable for injuries sustained while inattendance and/or participating in any activity. Also, if a child is removed or quits from a team for any reason no refunds will be given.

I have also read the WCYFA Football Guidelines. I agree to have a clear understanding of the guidelines and expectations.

I have read, understand, and agree without exception to the terms and conditions stated above: *

Football Experience (explain below):

Please list 3 jersey numbers your student athlete would prefer to wear.:

Signature:

Date:

* indicates required fields

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2015 Football Player Registration