Pickup Football Liability Waiver
Please complete this form to participate in the pickup football game. Your information is required for safety and liability purposes.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions or allergies we should be aware of?
Have you experienced any injuries in the past year that could affect your participation?
*
No
Yes (please describe below)
If yes, please describe your injury:
Which dates are you planning to participate?
Participant Signature (Parent/Guardian if under 18)
*
Submit Waiver
Submit Waiver
Should be Empty: