HB Chargers Football Registration Backup Form

PARTICIPANT INFORMATION
Player First Name*
Player Last Name*
Date of Birth*

MonthDayYear
Age On 7/31/2025*
Grade in School for 25/26 School Year*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT/GUARDIAN 1 INFORMATION
Parent/Guardian 1 First Name*
Parent/Guardian 1 Last Name*
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
PARENT/GUARDIAN 2 INFORMATION
Parent/Guardian 2 First Name*
Parent/Guardian 2 Last Name*
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
EMERGENCY CONTACT INFORMATION

Cannot be Parent/Guardian Listed Above
Emergency Contact First Name*
Emergency Contact Last Name*
Relationship to Player*
Emergency Contact Number*
Please enter a valid phone number.
TACKLE FOOTBALL EXPERIENCE
Has the player played tackle football before? If yes, please provide details (teams, years played, positions)*

YESNO
Please provide details (teams, years played, positions)*
OTHER
Coach/Friend/Sibling Request?
(Requests will be considered, but are not guaranteed)
Are you interested in volunteering? If yes, please indicate your interest(s) below:*

YESNO
Please indicate your interest(s) below:*

Coaching StaffTeam ParentAthletic Director/Team Manager
Are you interested in learning more about our business sponsorship opportunities?*

YESNO
PARTICIPATION AGREEMENT
I, the undersigned, acknowledge that my child wants to participate in the Huntington Beach Chargers tackle football program. I understand that participation involves risk of injury, and I release the coaches, organization, and all associated personnel from any liability for injuries sustained while participating in this activity.

I hereby grant the Huntington Beach Chargers permission to use my child's name, image, and likeness in any promotional materials related to the program. I understand that this may include photographs, videos, and other media formats. This consent is provided without financial compensation or further approval needed.

I understand that there is a no refund policy and that I will be responsible for any outstanding payments and fees due if I choose to withdraw my child from the program.
Parent/Guardian Signature*

Clear
PAYMENT INFORMATION

My Products*

Pay In FullFull Registration Fee

$550.00

Payment Plan$150 deposit due now, balance is due by 8/15/2025. Additional payments can be made via online payment link. You will be sent an email with additional instructions.

$150.00

Enter coupon

Total

$0.00

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

*The payment plan must be paid off in full regardless of the player quitting or getting injured.
Should be Empty:

PARTICIPANT INFORMATION

PARENT/GUARDIAN 1 INFORMATION

PARENT/GUARDIAN 2 INFORMATION

EMERGENCY CONTACT INFORMATION

TACKLE FOOTBALL EXPERIENCE

OTHER

PARTICIPATION AGREEMENT

PAYMENT INFORMATION