2011 Flag 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 *
Method of Payment *
 Paypal (Visa, MC, Discover) 
 Check 
How did you hear about us? *
If you are a returning player, which year did you last participate? *
Comments Suggestions?
I consent to pictures of my child to be posted on the MPYFL Website *
 Yes 
 No 
Sibling Playing/Cheering *
 Yes 
 No 
Jersey Size
 Y-2XS 
 Y-XS 
 Y-S 
 Y-M 
 Y-L 
 Y-XL 
 A-S 
 A-M 
 A-L 
 A-XL 
 A-XXL 
 A-XXXL 
1st Number Choice
2nd Number Choice
3rd Number Choice