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Holly Stampede Youth Football and Cheerleading

Holly Stampede Youth Football and Cheerleading

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Holly Stampede Youth Football and Cheerleading

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Football
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Contact

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Flag Football Registration For 5/6 Years Old

Home/Registration/Step #2: Team Registration Forms/Flag Football 5/6

Step #2: Register

Flag Football 5/6

Team Info

I understand I am registering for the following league: *

Flag Football 5/6 years old

Player Info

Player First Name: *
Player Middle Name:
Player Last Name: *
Date of Birth: *
Gender: *

Male Female Unspecified
Upload Birth Certificate: *
Address: *
Address Line 2:
City: *
State: *
Zip Code: *
School: *
Grade (Upcoming School Year 2024-2025): *
Upload Proof of Grade: *

Registration Documents

I have read and agree to the Anti-Bullying Contract.*
I have read and agree with the Amateur Minor Athletic Waiver & Release.*
I have read and agree to the Medical Treatment Consent form.*
I have read and agree to the Code of Conduct.*
I have read and agree to the Heads Up Concussion document.*

Parent/Guardian Info

Parent Guardian First Name: *
Parent Guardian Last Name: *
Parent Guardian Cell Phone: *
Parent Guardian Email: *
Secondary Parent Guardian First Name:
Secondary Parent Guardian Last Name:
Secondary Parent Guardian Cell Phone:
Secondary Parent Guardian Email:

Emergency Contact Info

Primary Emergency Contact First Name: *
Primary Emergency Contact Last Name: *
Primary Emergency Contact Relationship to Player: *
Primary Emergency Contact Phone: *

Insurance Info

Medical Insurance Company: *
Medical Insurance Group Number: *
Medical Insurance Policy Number: *
Medical Insurance Policy Holder: *
Medical Insurance Phone Number:

Physician Info

Physician First Name: *
Physician Last Name: *
Hospitial of Choice: *

Medical History

Does the player have any allergies that we need to be aware of?: *
Please list all player allergies: *
Does the player have any medical conditions that we need to be aware of?: *
Please list all player medical conditions: *

Payment Terms

Payment & Registration Terms: *

I agree registration is not final until payment is made in full.
Failure to Pay: *

I understand that failure to pay by 6/30/2024 will cause the loss of placement on desired team.
Refund Policy: *

I understand there will be no refunds on payments made after 6/30/2024.

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