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2023 QUARTERBACK PREPARATORY REGISTRATION FORM
Event Timing: Saturday, June 10, 2023
Event Address: 1001 Freeman Mill Road Greensboro, NC 27406
Contact us:
waynedallas.qbprep@gmail.com
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Email
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Your email
PARTICIPANT INFORMATION
Note: This form is required prior to participation. Participation will not be permitted until this application has been completed, and the participant has been accepted and notified.
Name
*
Your answer
Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade In School (Fall 2022)
*
Your answer
Are you a Boys and Girls Club Member?
YES
NO
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Are you a member of the Boys and Girls Club of Greensboro?
*
YES
NO
Football Position
*
Your answer
Home Address
*
Your answer
Email Address:
*
Your answer
Phone Number
*
Your answer
Parent(s) Name(s)
*
Your answer
How many parents will attend
*
Your answer
Coach Name
*
Your answer
High School
*
Your answer
Will your coach attend?
*
YES
No
Required
MEDICAL INSURANCE INFORMATION
Do you or anyone in your household have symptoms of COVID-19?
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Choose
YES
No
Company
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Your answer
Company Phone Number:
Your answer
Name of Person Insured:
Your answer
Medical Insurance ID #
*
Your answer
EMERGENCY CONTACT INFORMATION
Emergency Contact Name
*
Your answer
Relationship to Participant:
*
Your answer
Emergency Contact Phone: Cell
*
Your answer
Emergency Contact Phone: Work
*
Your answer
Emergency Contact Phone: Home
*
Your answer
NOTE: Quarterbacks need a football and all athletes must wear workout gear - practice shorts, t-shirts, socks, and sneakers. Football cleats are optional.
A copy of your responses will be emailed to the address you provided.
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