Register – Football Life

Name of Parent/Guardian *

First

Last

Name of Child *

First

Last

Age of Child (6-13) *

I give permission for the following:

Health Declaration (Any known allergies)

Health Declaration (Any disabilities)

Emergency Contact Name #1 *

First

Last

Emergency Contact Phone #1 *

Emergency Contact Name #2 *

First

Last

Emergency Contact Phone #2 *

Permission & Agreement *

I agree that the information stated above is correct and that it may be distributed to Football Life Coaches.

Signed (Parent/Guardian Print Name) *

Parent Declaration Form