Adult registration and release form for FFSA only
Authorization, release and waiver of liability, indemnity agreement.
Player's Last name*
Firs Name *
Middle Name
D.O.B. *
Male/Female
Address *
City *
State / Province *
Zip Code *
Country *
Email *
Phone *
Cell
Work Phone
Name of Doctor
Phone
Insurance Company
I/we have read this instrument and understand all its terms.
I/we execute it voluntarily and with full knowledge of its significance
See Disclosure
* Required Fields
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