Registration
Wantagh Football Club
Football & Cheerleading
200
3
Registration Form
Please type in all information and press PRINT FORM at bottom of page.
Child's Name
Uniform Preference #
or
or
Address
City
, NY, Zip
Date of Birth
Telephone #
Registration is for
Football
Cheerleader
Parent (s) / Guardian (s) Information
Name
Address
City
, NY, Zip
Telephone #
Work#
Cell #
Pager #
Email Address
Emergency Contact
Person to Contact
Telephone #
Work#
Cell #
Pager #
Address
City
, NY, Zip
For Older Browsers use the File Menu then select Print
Please sign & date this form in the spaces provided and mail it with your check to:
Wantagh Football Club
PO Box 3682
Wantagh, New York 11793-3682
The undersigned parent (s) or guardian (s) of the above named applicant hereby gives permission for the applicant to participate as a player or otherwise in the activities of the Wantagh Football Club. He/She is in good physical condition and has no medical reason we should be aware of unless specified below. I agree to indemnify and save harmless the Wantagh Football Club, its officers, representatives and coaches from any and all claims, expenses and causes of action arising out of the applicant's participation or loss arising from injuries not covered by or exceeding any insurance covering such loss.
Comments:_______________________________________________
Medical Conditions (if any):___________________________________
I certify the above information is correct to the best of my knowledge and agree to take full responsibility for the maintenance, upkeep and return of any equipment provided by the Wantagh Football Club.
Dated:____________________
Signature of Parent or Guardian________________________________
