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First Name

Last Name

Date of Birth

Gender

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Email Address

Street Address

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Home Phone

Cell Phone

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Team Name

Medical Condition(s)/Allergies

I am willing to volunteer as a(n)

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

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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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