CMYFL Senior Player & Cheerleader Registration Form

Please fill out the form below to register player(s)/cheerleader(s). You will receive an e-mail confirmation sent to the mail address specified in the form after the registration has been processed. Please call Lou Lippa (804) 937-8444 if you don't receive your registration confirmation.

Please complete the registration form below and click submit.

* = Required Fields

Signing up for	Football Cheerleading
*Last Name
* First Name
Middle Initial
Address
City
Zip
*Home Phone Number
Cell Phone Number
*E-Mail for Confirmation
Sex	Male Female
Date of Birth
Football Age	Age on 9/30/2008
Height	ft inches
Weight
Jersey Number
Shirt Size	Youth S M L XL Adult S M L XL XXL Check One
Pants Size	Youth S M L XL Adult S M L XL XXL Check One
Pertinent Medical Information	(Allergies, medication, hearing, vision, disabilities, etc.)
Other Senior League Obligations: (Please indicate which days of the week)
Father's Last Name
First Name
Home Phone #
Work Phone #
Cell Phone #
E-Mail Address
Volunteer
	(Use the <Ctrl> key to select multiple items)
Mother's Last Name
First Name
Home Phone #
Work Phone #
Cell Phone #
E-Mail Address
Volunteer
	(Use the <Ctrl> key to select multiple items)
How did you hear about us

*** Note to parents: Regular season jerseys are kept by the players and can be altered at the player's expense.

No uniforms will be issued until registration fees are paid in full.

REGISTRATION FEES

FOOTBALL

Ages 14, 15 & 16 - $175.00

CHEERLEADING

- $150.00 (cheerleading)

*** Fees include name and number on the back of the jersey.

*** Uniforms will not be issued until fees are paid in full.

***Parent(s) and Player(s) must complete and sign a "CODE OF CONDUCT FORM" as part of the sign up process

I/We the parents of the above named candidate for a position on a CMYFL League team, hereby give my/our approval to participate in any and all CMYFL League activities including transportation to and from the activities. I/We know that participation in FOOTBALL may result in serious injuries and protective equipment does not prevent all injuries to players, and do hereby waive, release, absolve, indemnify and agree to hold harmless the CHESTERFIELD METRO YOUTH FOOTBALL League,the organizers, sponsors, supervisors, participants and persons transporting my/our child to and from activities for any claim arising out of any injury to my/our child whether the result of negligence or for any other cause except to the extent and in the amount covered by accident of liability insurance. I/We will furnish a certified birth certificate of the above named candidate to League Officials.

Once you click the submit button below you will be directed to our secure payment page. You will be required to create a simple login ID and password. Once you have done that you will be able to pay using your credit card.

If you do not wish to pay at this time you may close the payment window when it opens. Your son/daughter will still be registered BUT will NOT have a spot on a team until they are paid in full.

Copyright ) 2004 [CHESTERFIELD METRO YOUTH FOOTBALL LEAGUE]. All rights reserved. Revised: JUNE 1, 2004