YOUTH PROFESSIONALS SPORTS DEVELOPMENT (Football Only) Sports Registration
Please only use one form per child. (Must have for cheerleaders) Family E-mail address .
* Required
Email address
*
Your email
FOOTBALL INFORMATION:
Today's Date
*
MM
/
DD
/
YYYY
Football Player
*
Football Player
Cheerleader
Basketball
FOOTBALL PLAYER INFORMATION
(Player) First and Last Name
*
Your answer
(Player) Gender
*
Female
Male
(Player) Birthday
*
MM
/
DD
/
YYYY
(Player as of May 31st 2018) Age
*
Choose
5
6
7
8
9
10
11
12
13
14
(Player ) Please list the school
*
Your answer
Will the child try out for Middle School football: Y / N
*
Yes
No
Maybe
Please list the names and ages of siblings who will also be participating in the Y.P.S.D.:
*
Your answer
PARENT/ GUARDIAN INFORMATION
Parent(s) First and Last Name
*
Your answer
Relationship to player
*
Choose
Mother
Father
Grandparent(s)
Guardian
Full Address, City, State, Zip
*
Your answer
Contact Number
*
Your answer
Emergency Information:
Please complete
Emergency # (Other than parents #)
*
Your answer
(Emergency) Relationship to player:
*
Choose
Grandmother
Grandfather
Aunt
Uncle
Father
Mother
Guardian
Child's Doctor
*
Your answer
Doctor's contact
*
Your answer
Hospital Preference
*
Your answer
Name of Insurance Company & Policy Number:
*
Your answer
Please list any physical or medical problems (to include allergies, medications, asthma) that the league should be made aware of:
*
Your answer
Comments:
Your answer
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