Little Ferns Registration Form

Little Ferns Football

Registration Form
PLAYER INFORMATION
Full Name:

First NameLast Name
Birth Date:

MonthDayYear
I authorize Little Ferns football to use my child's image and/or likeness in official media, including: Our website, promo material, newsletters and related media.
PARENT/GUARDIAN
Full Name:

First NameLast Name
E-mail:
Mobile Phone:

Area CodePhone Number
EMERGENCY CONTACT INFORMATION
Full Name:

First NameLast Name
Relationship to Player:
Mobile Phone:

Area CodePhone Number
WAIVER INFORMATION
I hereby give my approval for my child’s participation in any and all activities prepared by Little Ferns football during the selected activities. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Little Ferns football and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected football sessions. In case of injury to said child, I hereby waive all claims against Little Ferns football, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Health/Physical Limitations (if any):
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature
Your childs place will be confirmed once full payment is recieved. Please send payment to R O'Leary 12-3118-0067343-01 Using childs name followed by LF as reference.
Additional notes
Should be Empty:

Little Ferns Football

PLAYER INFORMATION

PARENT/GUARDIAN

EMERGENCY CONTACT INFORMATION

WAIVER INFORMATION