2017 Regular Season Registration Form  

Regular Season Registration

Child's Name



Child of a certified Cavalier Youth Football coach

Address

City, State & Zip

Child's Date of Birth

Age on Aug 31, 2017

Grade Completed

If you attend a church, which one?

School attended 2016-17

School attending 2017-18

Legal Guardian

Mother's Name

Father's Name

Home Phone

Mother's Cell

Father's Cell

Email

Emergency Contact Name

Emergency Contact Phone

Insurance Company

Policy Number

Insurance Phone

MEDICAL & LIABILITY RELEASE: In case of an emergency you are authorized to take such measures and arrange for such medical and hospital treatment as you may deem advisable for the health and well-being of my child. I release Calvary Baptist Church, staff, and volunteers from claim or liability due to sickness or injury. I attest to the fact that the above named child is covered by an insurance policy covering illness and injuries (and/or) I accept all financial responsibilities concerning any medical emergency. I also accept responsibility to have my child picked up immediately in the event of illness, accident or disciplinary reasons.

I accept the above release.

Full Name






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