Name of Participant:
*
Name of Parent:
PLAYERS 14 - 17 YEARS OLD
Date of Birth
*
Gender:
*
Male
Female
Position that you play in:
Any Medical Illness?
*
No
Yes
If yes, please state the illness:
Email:
*
Telephone Number:
FEES: $25
Payment:
Cash ( Can be paid at the event)
Check
Comment:
By submitting this form, you agree to indemnify and to hold harmless Footy Promotions, its members, coaches, officers or designates from any kind of claim whatsoever.
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