2011 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
*
Grade 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
Emergency Contact Name
*
Emergency Contact Number
*
Emergency Contact Relationship to the Child
*
Name of Insurance Carrier
*
Any Medical Conditions
*
Parent Acknowledgement of the Program/Rules
*
Select Yes/No
Yes
No
I will be submitting my payment via paypal or check?
*
Paypal (Visa/MC/Discover)
Check
How did you hear about us?
*
Please Select
School
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Returning Player
Friend-Referral (if so, specify in comments section
MPYFL Website
Chamber of Commerce
Email
If you are a returning player, which year did you last participate?
Select Year
N/A
2010
2009
2008
2007
Comments Suggestions?
I consent to pictures of my child to be posted on the MPYFL Website
*
Yes
No
Sibling Playing/Cheering
*
Yes
No
Additional Comments
Jersey Number Pref #1
Jersey Number Pref #2
Jersey Number Pref #3
Jersey Size (ex: Y-M; A-L)