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First Name

Last Name

Date of Birth

Gender

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Email Address

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Registration Type

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Team Name

Medical Condition(s)/Allergies

I am willing to volunteer as a(n)

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In Case of Emergency Name of local friend or relative (Not living at same address)

Home Phone

Cell Phone

By my submission of the registration form, and payment of the registration fee, I hereby participate in any and all M.Y.A. SPORTS activities. I also waive, release, absolve, indemnify, and hold harmless M.Y.A. SPORTS, facilities used by M.Y.A. SPORTS, Seminole County & Orange County School Board, their officers, directors, sponsors, drivers, employees, coaches, and volunteers for any claim arising out of an injury to the player named above. I acknowledge that in all sports there are certain risks of physical injuries, and all players participate at their own risk. Further, I agree to abide by all rules, regulations, and guidelines established by M.Y.A. SPORTS. A $35 fee will be assessed for returned checks for insufficient funds. Player Signature

Please initial here if you would like to opt out of all photography done by M.Y.A. SPORTS

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