Flag Football Registration | Boys & Girls Club Of Round Valley

Participant's Name: *

Birthday *

Grade: *

Age as of 7/1/2021: *

Gender: *

Boy
Girl

Jersey Size:

Parent/Guardian: *

Parent/Guardian Phone: *

Physical Address:

Address Line 1

Address Line 2

City

State

Zip Code

Confirm Town For Scheduling Purposes: *

Email *

Emergency Contact Name: *

Emergency Contact Phone: *

Do you have other children you want to register?

Yes
No

Please list the names of the other children you want to register. NOTE: you will need to register each child separately.

Waiver
I, the parent/guardian of the child, agree to abide by The Boys & Girls Club of Round Valley (BGCRV) and NFL Flag Football Program. I hereby waive and release any and all claims for damages I may have against BGCRV, the Town of Eagar (TE), and the Round Valley School District (RVSD), individual members thereof and all the officers, agents and employees, free from loss or damage, liability, injury, cost of expense, that may be suffered by the child while participating with and/or practicing as a part of this program. I certify that I will abide by all rules, regulations and conditions as prescribed by the RVSD and NFL Flag Football Program who make this program possible.

I realize that in order for my child to play, they will be required to purchase and wear a mouth guard during practices and games. *

Yes

Would you like to purchase a mouth guard from the league @ $5.00? *

Yes
No

Photo Release: I hereby grant permission to the BGCRV to use photographs and/or video of my child in publications, news releases, online, and in other communications related to the mission of the BGCRV.

Yes
No

Do you have insurance? *

Yes
No

Parent/Guardian Signature (use mouse to sign): *

Signature Date: *

To Register:
1. Registration form is completed and signed by parent or guardian. A phone number is required, preferably a cell number.
2. Registration fee must be paid in full. $40 per player.
**For further information you may call Danielle Whitaker @ 928-245-9924 (Scholarships available upon request)

Willing to volunteer?

Coach
Assistant Coach
Referee

Registration Fee: *

Price: $ 40.00

$25 Late Registration Fee (After 8/31/2021) *

Price: $ 25.00

Mouth Guard:

Price: $ 5.00

Total

$ 0.00

Billing Name *

First

Last

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pay securely with your credit card *

Card Number

Expiration

/

Security Code

2021 BGCRV Flag Football Registration

Flag Football Registration Form:

Flag Football
Registration Form: