This document contains a registration form for a flag football league. It collects information such as the player's name, contact details, age, school, insurance information, and permission from parents to participate. Players can register for either the spring session, summer session, or both, and payment is required upon registration.

1. Official Use Only
BMF&C FLAG FOOTBALL
Jersey # ________
2014 Registration
Player’s Name: _______________________________________
Phone: ___________________________
Address: ___________________________________________
Cell Phone: _______________________
Email Address: ______________________________________
Date of Birth: _____________________
School: ____________________ Present Grade: _________
Birth Certificate: Yes or No _________
(ONLY for new members)
officer initials
Age as of 6/14/2014: __________
NEW PLAYER / RETURNING PLAYER
Team: ___________________________
Do you have a sister/brother already on a team? _______
If yes, what team? _________________
Fathers Name: ____________________________
Mothers Name: _____________________________
With whom does the child reside? _____________________________
Name of Insurance Carrier: ______________________________ Policy #: _________________________
I/We certify that the above information is correct. I/We give permission for my/our child to participate in the Bloomsburg
Midget Football Program. I/We understand that Medical Insurance covering my/our child is required and is my/our
responsibility. I/We, the parents/guardians of the above named participant of Bloomsburg Midget Football League, Inc.,
hereby give my/our approval to participate in any and all Bloomsburg Midget Football activities, including transportation
to/from activities. I/We understand that participation in midget football may release, absolve, indemnify and agree to hold
harmless Bloomsburg Midget Football League, Inc., the organizers, sponsors, coaches, other participants and persons
transporting my/our child to/from activities for any claim arising out of any injury to my/our child whether the result of
negligence or any other cause. A completed emergency form will be required for all players once the practice season
begins.
$45.00 (including shirt and shorts) for one session or $60.00 for both spring and summer
Choose the session(s) for which you are registering:
________ Spring
________ Summer
________ Both
Signature of Parent/Guardian: _____________________________________
JERSEY SIZE:
Date: _______________
SHORT SIZE:
Youth
S
M
L
XL
Youth:
S
M
L
XL
Adult
S
M
L
XL
Adult:
S
M
L
XL
Officer Use Only
Date: _________________ Registration fee pd: ________ Check #: ________ Cash: ________ Officer initials: ________