2017 Fall Tackle Registration Form
Player Last Name
First Name
Birth Date
Year/Month/Day
Medical #
Mailing Address
Postal Code
Parent/Guardian Name
Phone Number
Emergency Contact Name Phone Number

Division
Cell Phone Number
Email Address
Cell Phone Number
Relationship to Player
Age as of Dec 31st
Fall Tyke (2009)
Fall Atom (2008-2009)
Fall PeeWee (2006-2007)
Fall Junior Bantam (2004-2005)
Fall Bantam 9 Man(2002-2003)
Fall Midget 9 Man(1999-2001)
Mini Flag (2010-2012
Fees
$150
$300
$300
$300
$300
$300
$300
$200
Equipment Deposit
Refund Policy details: *all refunds will be charged a $25 administration fee
If a player is injured or quits prior to July 31st - 100% refund
Tackle Season If a player is injured or quits from September 10th - 50% refund.
If a player is injured or quits after September 10th - no refund.
Spring Season If a player is injured or quits prior to April 15 – 100% refund, minus costs of 2 jerseys & admin fee No refunds
after April 15th
$400
$400
$400
$400
$400
$400
$400
$100
CONSENT: I hereby approve and consent to the above named person participating in the Richmond Minor Football Association program on behalf of
myself, members of my family, my heirs, administrators and assigns, forever release, discharge and hold harmless Richmond Minor Football League and
its members or volunteers from loss and any or all liability arising from any act or omission on their part resulting from any injury, fatality, illness or
damage of property occurring as a consequence of the said participant. I also acknowledge that I have read and understand the terms of conduct set out in
the RMFL’s conduct policy and accept the terms and understand the consent which I now sign.
Copy of player’s birth certificate must accompany registration form. .
Parent or Guardian [print]
Parent or Guardian [signature]
Date
Volunteers needed: Parent participation is vital to the successful running of minor football. Please indicate where you will contribute.
 Manager
 Fund Raising Committee
 Coaching Staff
 Equipment Room Helpers
 Executive Board
Registrar Use Only
Name on Cheque or Credit Card
Registration Fee
Equipment Deposit
Volunteer Deposit
Copy of Birth Certificate  Received
 Player Data Entered
 Returning Player
CHQ
CC
Cash
K/S