Myers Park Ultimate Participant Registration 2016
Checklist:
1) Complete this online form
2) Print and sign the Charlotte Ultimate Waiver (linked below)
3) Print and sign the Charlotte Ultimate Medical Authorization form (linked below)
4) Send registration fee to Charlotte Ultimate.

Registration includes a disc, jerseys (shorts, and two shirts, only if you do not already have them), league dues, practice and game space, and club administration.  Jersey, travel and tournament costs are not included.

Fee: $40 for returning players who already have a jersey (it is the same as last year) or $100 for players who need jerseys.

This can be sent via paypal to charlotteultimate@gmail.com, check payable to Charlotte Ultimate, or cash.  Checks and cash can be given to a coach at practice.
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Player First Name *
Player Last Name *
Player Email
Re-type Player Email
Gender *
Date of Birth MM/DD/YY *
MM
/
DD
/
YYYY
Player Cell Phone
School Year 2015-16 *
New or Returning Player *
Do you need a new set of jerseys (white shirt, green shirt, and shorts)? *
Jersey Size
These are adult sizes
Clear selection
Jersey Number
Please provide your top three choices
Address
City
State
Zip
Parent 1 First and Last Name *
Parent 1 Email *
Parent 1 Cell Phone *
Parent 2 First and Last Name
Parent 2 Email
Parent 2 Cell Phone
Family Physician Name *
Family Physician Phone *
Preferred Hosptial *
Player Medical Insurance Carrier *
Player Medical Insurance Group # *
Emergency Contact Name *
Emergency Contact Cell Phone *
Player allergies, medications, chronic illnesses, or other conditions which a physician should be alerted to *
Questions and/or comments
Which tournaments are you available for? *
Required
List any Thursday games you anticipate missing from March 17-May 19. *
Registration Forms
Charlotte Ultimate Waiver

https://drive.google.com/file/d/0B9ic5SGxN5yedDh1SUlTVkxQZ3c/view?usp=sharing

Charlotte Ultimate Medical Authorization Form

https://drive.google.com/file/d/0B9ic5SGxN5yeYi1idWFnNzJwLUk/view?usp=sharing
I have read and agree to all Expectations, Forms, and Waivers in the on-line registration
Signature of Player *
Signature of Parent *
Submit
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