MENTOR FLAG FOOTBALL REGISTRATION FORM

Parent Name (first and last)*

Email (most commonly used)*

Cell and Secondary Cell (for emergency contact)*

Address & Postal Code*

Child's Name (first and last)*

Child's Birth Date (numeric - month/day/year - 00/00/0000)*

Gender (M/F)*

Family member interested in being a referee? Please provide name (must be 16 years +). (Yes/No)*

Are you interested in coaching (we provide a 20% refund on your registration fee) (Yes / No)*

Does your child pay a rep sport? If so, what sport and level of Rep?*

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