Registration Form

YOUTH FOOTBALL REGISTRATION FORM

COMPLETE ONE FORM PER CHILD

A PHYSICAL EXAM IS REQUIRED FOR ALL PARTICIPANTS AT LEAST EVERY TWO YEARS

Please check here if interested in camp:

Participant's Name:

Age:

Date of Birth:

Address:

City:

State:

ZIP Code:

Parent/Legal Guardian's Name:

Home Phone:

Cell Phone:

Work Phone:

Email Address:

Registration Fee ($):

IN CASE OF EMERGENCY

Contact # 1

Name

Address

Home Phone

Work Phone

Cell Phone

Contact # 2

Name

Address

Home Phone

Work Phone

Cell Phone

MEDICATIONS INFORMATION

Participant’s Allergies

Participant’s Medical Conditions

MEDICATIONS CANNOT BE GIVEN TO ANY CHILD OR ANYONE EMPLOYED BY THE SUPER SPORTS ELITE DEPARTMENT.

Name of Participant’s Physician

Physician’s Telephone

WAIVER OF LIABILITY RELEASE FORM

I am aware of the nature of this activity and I hereby assume responsibility for

to participate and to be photographed for publicity purposes. I will not hold the SUPER SPORTS ELITE and/or its employees responsible in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of the SUPER SPORTS ELITE prior to participation in this program.

Parent/Legal Guardian Signature

Date