SoCal Dolphins Youth Football & Cheer

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PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

First Name:

Last Name:

Email:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

First Name:

Last Name:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

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Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I/we agree with the above *

Signature:

Date:

Signature:

Date:

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