Boys & Girls Club of SEK Tackle Football 2023

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Boys & Girls Club of Southeast Kansas 2023 Football Registration Form

For students starting 5th & 6th grade *Cost is $150 per child - cash or money orders only - payment is due at required parent meeting August 15 @ 6:00 PM (no exceptions). Students will also be fitted for uniforms at the required parent meeting.
*Parents are required to purchase football pants for their player(s)

Questions - griffin.walker@cvilleschools.com Switch account

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* Indicates required question

Player First Name *

Player Last Name
*

School

Has your child/children ever participated in tackle football? *

Yes

Date of Birth *

YYYY

Grade (August 2023 School Year) *

5th Grade

6th Grade

Jersey Size *

Youth S

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

Mother/Guardian Name
*

Father/Guardian Name
*

Address
*

Phone Number *

Email
*

Phone
*

Insurance Name
*

Insurance Policy Number
*

Emergency Contact Information: Name, phone number, and relationship to child. *

Relationship to Participant
*

Mother

Father

Grandparent

Family Friend

Legal Guardian

Other:

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