Wantagh Football Club

WFC
PRIDE

WANTAGH FOOTBALL CLUB REGISTRATION

2011 SEASON - REGISTRATION CLOSED

Player Information

You may register up to 4 children within your family. The name must match your child’s birth Certificate or passport exactly.

Player 1	First Name	Last Name	D.O.B (mm/dd/yyyy)
Player 2	First Name	Last Name	D.O.B (mm/dd/yyyy)
Player 3	First Name	Last Name	D.O.B (mm/dd/yyyy)
Player 4	First Name	Last Name	D.O.B (mm/dd/yyyy)
Player's Address
Street City State Zip

Parent(s) / Guardian(s) Information

Name 1		Name 2
Street		Street
City		City
State		State
Zip		Zip
Home Phone		Home Phone
Other Phone		Other Phone
Email		Email

Please be sure to provide a correct email address.
The WFC will use this to communicate club announcements.

Emergency Contact Information (Different from above)

Name		Family Doctor
Home Phone		Phone
Other Phone		Street
		City
		State
		Zip

Acknowledgement Waiver

By checking “I Accept” below, I give approval for my child to participate in all activities of the Wantagh Football Club during the season I assume all risks and hazards incidental to the program. In case of an emergency, I hereby authorize any necessary treatment.

I Accept