Midland Rattlers Football & Cheerleading

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2019 Midland Rattler Football & Cheer Registration

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

Did your child for Midland play last year? If so, for what team?:

I would like to coach or assistant coach for my child's team.

PAYMENT WILL NEED TO MADE AN ON-SITE REGISTRATION DATE. LAST DAY OF REGISTRATION IS 07/08/2019

FEES:

-FLAG FOOTBALL (7 & 8 YEAR OLDS) - $70
-TACKLE FOOTBALL (9-12 YEAR OLDS) - $125 (ADDITIONAL $25 FOR PAD AND
HELMET RENTAL)
-CHEERLEADING (4-13 YEAR OLDS) $115

I UNDERSTAND THAT THIS PROGRAM IS DEPENDENT UPON FUNDRAISING, SPONSORS AND DONATIONS. AS A PARENT/GUARDIAN I WILL BE CALLED UPON TO SUPPORT THE LEAGUE BY WORKING IN THE CANTEEN AND PARTICIPATING IN ALL FUNDRAISING EVENTS. *

Do you have another child playing? (We offer a discount for each additional child registered)

My child has permission to participate in the Midland Football & Cheer Program. I will not hold any member or volunteer to the league responsible for any injury that may occur. *

I understand my dues must be paid in full prior to July 8, 2019. *

* indicates required fields

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2019 Midland Rattler Football & Cheer Registration