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2012 Warrior Youth Football

Registration Form
Player Information
First Name Date of Birth Last Name Grade/School

Parent / Guardian Contact Information


First Name Home# Relationship Acknowledgement of Waiver
The undersigned parent/guardian acknowledges that the City of Warrior, Warrior Community Park, Warrior Youth Football, Coaches, Officials, Referee, and participants are not responsible for any injuries, received by any child or participants. The undersigned hereby waives and releases the City of Warrior, Warrior Community Park, Officials, Referees, and Coaches, and participants from all liability for injuries received by any children or participants for and inconsideration of the child's or participant's involvement in activities with the Warrior Community Park.. Agreed to this __________day of ___________, 2012 Signed:_______________________________________ Print Name: ___________________________________

Last Name Cell# Email

Filled out by the Park


Jersey Number Jersey Size Helmet Size Jersey 2
nd

Choice

Shoulder Pad Size Pant Size

Payment Information
Cash Check# ______ Amount Paid $_ _____ Receipt# _________ Date

Payment received by

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