Howards Grove Youth Football Registration

Howards Grove Youth Football Registration Form

Player information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What grade will the student be in the Fall?*

Age*

Parent information

Parent/guardian name*

First NameLast Name

Email*

example@example.com

Primary phone number*

Area CodePhone Number

Secondary phone number

Area CodePhone Number

We are in need of coaches and assistants in order to keep the league running smoothly. Please check if you would help in any of these areas:

CoachAssist a coachNo, I do not want to coach

Consent to medical treatment for minor

Family physician*

For the following question, please include Insurance Company Name, Plan Name or Number, Member Number, Group Number and Provider Contact Phone Number

Insurance*

Medical facility*

Allergies/conditions/special instructions

Consent*

In the event of an emergency, I/we hereby authorize transport and emergency medical care to be administered to the above listed player before our arrival.

Concussion information and waiver

Please take the time to read the Concussion Information and Waiver by clicking the link below. By checking the box below, you are indicating that you (as a parent or guardian) and the player have read, understand, and agree to the terms described.

Signature

Parent/Guardian Signature*

Please verify that you are human*

Please select your league (grade in the Fall)

Grade: Kindergarten through 2nd$25.00

Please enter a short description.

Grade: 3rd through 4th$40.00

Please enter a short description.

Grade: 5th through 8th$75.00

Please enter a short description.

Total $0.00

Pay with PayPal

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info