Reg. Youth FFSA     Print
 

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Youth registration and release form for FFSA only

Parent/Guardian Authorization, release and waiver of liability, indemnity agreement. Minor's Request for permission to Participate in FFSA program.

 Minor Player's Last name* 

  

Firs Name * 

 

Middle Name  

 

D.O.B. * 

 

Male/Female *

   
  Parent(s)/Guardian(s)

Father/Mother * 

 

   
  Mailing address

Address * 

 

City * 

State / Province * 

Zip Code * 

   

 Country * 

Email * 

Phones * 

  

   
  Above mentioned player HAS NO medical condition which will hold him/her from participating in FFSA programs.
   
  Insurance information

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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