EmailMe Form - 2014 Tackle Football Registration

Child's LAST NAME *

Child's FIRST NAME *

Gender

Male

Female

Date of Birth (MM/DD/YYYY) *

School Player will attend in the Fall *

Street Address *

City, State and Zip Code *

Name of Father

Name of Mother

or Name of Guardian

Home Telephone Number *

Cell Phone Number or Alternate Number *

Email Address

Please let us know the best way to communicate with you* *

Name of Insurance Carrier *

Any Medical Conditions *

How did you hear about us? *

If you are a returning player, which year did you last participate?

If you are a returning player, please list your team name.

LAST TEAM PLAYED FOR:

Jersey Number Pref #1 *

Jersey Number Pref #2 *

Jersey Number Pref #3 *

Jersey Size (ex: Y-M; A-L) *

Sibling Playing/Cheering *

****IF CHECKED YES PLEASE LIST SIBLING'S NAME IN THE COMMENT BOX BELOW****

Comments Suggestions?

Please initial to acknowledge that you have been notified that a DMV walker ID is required in order for your child to receive league issued football equipment. *

Please sign to acknowledge that you have read the MPYFL Code of Conduct Form. This form can be found on our website at: www.mpyfl.com/mpyflforms.html *

Please initial, stating you have read and that you are aware of MPYFL's refund process*

A FULL REFUND will be issued if requested no later than THE FIRST DAY of practice.

A PARTIAL REFUND will be issued if requested between the start of practice and the FIRST official MPYFL game.

AFTER the FIRST official game, NO REFUNDS will be issued. *

Payment Method *

Online Pay Pal

Cash

Check

(Visa/MC/Discover)

Parent Acknowledgement of the Program/Rules*

I consent to pictures of my child to be posted on the MPYFL Website* *

Parents Acknowledgement of the Program/Rules*
I consent to picture of my child to be posted on the MPYFL Website*

Please initial, stating you have read the Liability Release below and Agree with statement.

Liability Release:

I understand the nature and scope of the above listed program. I understand that there are risks and danger associated with the program. I understand that it is the function of Manassas Park Youth Football League, Manassas Park Youth Football League volunteer coaches to operate in order to guarantee that the safety of participants with respect to the activity(s). I also understand that each participant has the responsibility to exercise due care in the performance of the activity for the safety of himself/herself and the other participants. In consideration of my (the participant’s if under the age 18 and parent, legal guardian or legal custodian is signing for participant) being permitted to enroll in this activity, I hereby release, indemnify and hold harmless the Manassas Park Youth Football League and all volunteers from any and all claims, demands, costs, charges and expenses from harm, injury, damage or loss which may sustained by me (by participant if under age 18 and parent, legal guardian or legal custodian is signing for participant) as a result of or related to participation in this activity. *