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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 Information

Participant's First Name *

Participant's Last Name *

Age *

Date of Birth *

Email Address

Parent/Legal Guardian's First Name

Parent/Legal Guardian's Last Name

Country / Region

Address

City

State

ZIP Code

Cell Phone (optional)

Home Phone

Work Phone

In Case of Emergency — Contact #1

Name *

Address

Home Phone

Work Phone

Cell Phone *

In Case of Emergency — 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 by 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 the above-named participant to participate and to be photographed for publicity purposes. I will not hold 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 Super Sports Elite prior to participation in this program.

I have read and agree to the waiver above. *

Parent/Legal Guardian Signature (type your full legal name) *

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Insert Jersey Number or Name (optional)

Your Order

Product	Subtotal
Youth Football Registration × 1	$275.00
Subtotal	$275.00
Total	$275.00

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