Warren Blue Demons Football
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2012 Registration
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WARREN YOUTH FOOTBALL REGISTRATION
Child's First Name
*
Child's Last Name
*
Current Weight
*
Child's Mailing Address
*
City
*
State
*
ZIP
*
Home Phone (Incl.Atra Code)
*
Parents Email
*
Date of Birth
*
School Attending
*
School Grade Next Fall
*
Years Played Organized Football
*
Mother / Legal Guardian First Name
*
Mother / Legal Guardian Last Name
*
Work Phone Number
Cell Phone
*
Father / Legal Guardian First Name
*
Father / Legal Guardian Last Name
*
Work Phone Number
Cell Phone
*
Please provide the name of another person to contact if we are unable to reach either parent:
*
Emergency Contact First Name
*
Emergency Contact Last Name
*
Emergency Contact Cell Phone (Incl. Area Code)
*
DOES THE PARTICIPANT HAVE ANY OF THE FOLLOWING: (PLEASE CHECK)
RECENT SURGERY
EYE GLASSES OR CONTACTS
EPILEPSY
HEART DISEASE
SKELETAL DISORDERS
KIDNEY PROBLEMS
BRACES
ALLERGIES
BLOOD DISEASE
AUTO ACCIDENT
ASTHMA
LIVER DISORDER
HEARING LOSS
ALLERGIC TO BEE STINGS
OTHER
LIST ALL ROUTINE MEDICATIONS
PURPOSE FOR MEDICATION
IS THERE ANY OTHER INFORMATION THAT WE SHOULD KNOW?
Birth Certificate Declaration
WYF is no longer collecting the Birth Certificates of registered players. If there is a challenge to any WYF player’s age,
TCYFL will request the player’s Birth Certificate. It is the responsibility of the WYF player’s parent(s)/Guardian(s) to
submit the Birth Certificate to the WYF registrar within 36 hours of the request. Failure to submit the Birth Certificate
results in immediate removal of the WYF player from the WYF Program with no refund.