SoMD FlyBoyz Registration

Athlete First name

Athlete Last name

Birthday

Month

Day

Year

Gender

School Name

Grade Level

Parent/Guardian Information

Name

Emergency Contact Name

Emergency Contact Phone

3 Choices for Jersey #'s

Choice #1

Choice #2

Choice #3

Shirt Size

Nickname or name wanted on Uniforms

Personal Goals (Please be as detailed as possible)

How did you hear about us?

Medical Information

Medical Conditions

Allergies

Medications

Physician Name

Physician Number

Program Selection

Tackle Football (Early Bird $225, Normal $250, Late $275)

Travel Flag Football ($425 Annually)

Both

Pay based on your selected Sport above. Ensure you pay the corresponding amount for your selected sport when submitting the form

Liability Waiver

I, the undersigned, acknowledge and assume all risks associated with participation in SoMD FlyBoyz, Inc. football programs. I release SoMD FlyBoyz, Inc., its staff, and affiliates from any claims arising from participation.

Medical Treatment Authorization

I authorize SoMD FlyBoyz, Inc. staff to seek emergency medical care for my child if necessary

I confirm that the above information is accurate and that I agree to follow the rules and policies of the SoMD FlyBoyz, Inc.

Parent/Guardian Name

Student-Athlete Name

Date

Month

Day

Year