MYO Football Registration Form

Football League Registration Form
Date Today

MonthDayYear
Date
- Player 1 Name*
  
  First NameLast Name
- Player 1 Date of Birth*
  
  MonthDayYear
- Player 1 Age*
- KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth Grade
- Prefer not to answerAmerican Indian or Alaska NativeWhiteAfrican American or BlackAsianNative Hawaiian or Other Pacific Islander
- Player 1 Group (Determined by Fall 2023 Class)*
- Player 2 Name
  
  First NameLast Name
- Player 2 Date of Birth
  
  MonthDayYear
- Player 2 Age
- KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth Grade
- Prefer not to answerAmerican Indian or Alaska NativeWhiteAfrican American or BlackAsianNative Hawaiian or Other Pacific Islander
- Player 2 Group (Determined by Fall 2023 Class)
- Player 3 Name
  
  First NameLast Name
- Player 3 Date of Birth
  
  MonthDayYear
- Player 3 Age
- KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth Grade
- Prefer not to answerAmerican Indian or Alaska NativeWhiteAfrican American or BlackAsianNative Hawaiian or Other Pacific Islander
- Player 3 Group (Determined by Fall 2023 Class)

Emergency Contact Information
Name of Emergency Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Relation to Athlete*

Checkout Selection*

Tackle Football

Registered Tackle Football Participants$35.00

Select if registering 1 player/child.

Quantity

Flag Football

Registered Flag Football Participants$10.00

Select if registering 1 player/child.

Quantity

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Parental/Guardian Consent
Waiver I am fully aware that this sport activity may cause accidental injury to athletes. I likewise assume any and all possible risk that may cause injury, illness, or death arising to such activity. I hereby declare that I waive my right to pursue any and all claims against the Commission and the Organizing Committee of this event should in any case that the accident, injury, illness or death occurs in the course of any activity held by them.
Name*

First NameLast Name
Date Signed*

MonthDayYear
Date
Should be Empty: