Carmel Raiders Piedmont Youth Football League
Name___________________________________________ Home Phone: _______________
Age: _______
Birth date: ____ /____ /______
Parent’s Email _______________________________________________________________
Address____________________________________________________________________
City ________________________________ State__________ Zip___________________
School:________________________________________________ Grade:
_______________
Parent Name(s)_________________ ___________________ Work Phone______________
Do you have any organized football experience? Yes____________ No____________
If yes, what
league?___________________________________________________________
Approximate Height_______________________ Weight:____________________
Do you attend church regularly? _______ If yes which one? ___________________________
Insurance Information: Company _________________________________________________
Group
#________________________________Policy #________________________________
I understand that
Carmel Baptist Church will not be held liable in the event of any injury or
accident occurring
while participating in football with Carmel Baptist Church.
Parent’s Signature_____________________________________________________________
Date
_______________