12th Man FCC Family Movie and Fun Night Carnival Style Athlete Registration March 5, 2022
Please fill out the questionnaire bellow to participate as an athlete.
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Email *
Athlete Last Name *
Athlete First Name *
Age *
Birth Month *
Family Fun Night Activity *
T-Shirt Size *
What is the athlete's condition? Please be specific. *
Parent/Guardian Name *
Address (Please include zip code) *
Phone (Cell) *
Phone (Home)
I have read this release of liability and assumption of risk agreement, I fully understand its terms, I understand that I have given up legal rights by selecting accept and I accept it freely and voluntarily without any inducement. *
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First and Last Name of Parent or Guardian ( For Minor Age Athlete)
For Minor Age Athlete Parent or Guardian Please read and accept below.
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