Youth Flag Football League Registration Form

Flag Football 2024 - Registration Form

(ages 7 - 12)

Athlete Information

Player Name*

First NameLast Name

Player's age as of 8/12/2024

Date of Birth

School

Gender

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail*

yesno

Murfreesboro - 820 Jones Blvd.Smyrna - 198 Culbertson St.

Days/times my child cannot practice

T-shirt Size

RefereeOperate ScoreboardCoach a team

Individual ($65)Silver ($300)Gold ($500)

Important Notes

· Dress appropriately.

· Exhibit good sportsmanship.

· The league organizers reserve the right to form the teams to ensure the talents of all teams balanced.

· Fee: $65 - Current Boys & Girls Club member. $85 - non Boys & Girls Club member.

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

YesNo, I'll pay with cash.

Insurance Carrier

Name of Policy Holder

Subscriver ID/Group Number

Card Number / Card Date

YesNo

Please describe*

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at the Boys & Girls Clubs of Rutherford County may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Boys & Girls Clubs of Rutherford County and the persons in charge.

YesNo

Confirmation E-mail*

Signature*

After completing this form, please click Submit Form. You will receive a confirmation email. If you don't receive a confirmation email please contact us at 615.890.2582.

Registration fee:

$65 for current Boys & Girls Club members

$85 for non Boys & Girls Club members

My Products

2024 current member registration$65.00

2024 non-member registration$85.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country