Camrose Buffaloes
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Capital District Minor Football Association:
Player Registration and Parental Consent Form |
Player Information
Please circle one: ATOM PEEWEE BANTAM
7-10 YRS 10-12YRS 13-15 YRS
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Last Name:
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First Name:
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Middle Name:
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Address:
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City:
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Province:
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Postal Code:
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Home Phone:
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Email Address:
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Date of Birth:
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Years of Football
Experience: |
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Jersey Number:
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School Attending
in Sept. 2012: |
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Age (this calendar year):
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Weight in Pounds:
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Height in Inches:
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Measurement Date:
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Grade in Sept. 2012:
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Guardian Information:
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Guardian 1:
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Description:
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First Name:
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Last Name:
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Address:
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City:
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Postal Code:
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Home Phone:
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Work Phone:
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Guardian 2:
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Description:
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First Name:
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Last Name:
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____________________________
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Address:
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City:
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Postal Code:
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Home Phone:
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Work Phone:
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Parental / Guardian Certification
*I hereby certify that the above information is correct and that my child/ward is physically fit, and has my permission to participate in the CDMFA Football program.
*Since the CDMFA as a League seeks publicity, I understand and agree that the CDMFA from time to time may allow still and motion photographers to take pictures, action and pose, of above said player that may be used as promotional material or for reporting purposes for the League. I further understand that all rights of said photos belong to the League. Date _____________________
Parent/Guardian Signature ______________________ Players Signature ______________________
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Player Medical Details: |
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Name:
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Date of Birth:
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Address:
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Home Phone Number:
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Weight/Height:
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Years Football Experience:
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Jersey Number:
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Doctor:
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Emergency Contact:
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Medical Conditions:
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Allergies:
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Under Medical Care For:
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Current Medications:
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Implants:
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Comments:
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Signature:
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Print Name:
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Signature:
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Date:
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Information provided above is only for general reference. Please ensure that player information is
accurate and current. CDMFA is unable to confirm that information appearing on this page is accurate and or current.
