Registration Form

PLAYER INFORMATION

Player first name

Player last name

Date of birth

Month

Day

Year

Home address

Cell phone

School

Grade

Height

Primary position

PARENT/GUARDIAN INFORMATION

GUARDIAN 1

Guardian 1 Name

Relationship

Cell phone

Email

EMERGENCY CONTACT

Emergency Contact Name

Emergency Contact Phone

Medical Concerns / Allergies

PARENT VOLUNTEER INTEREST

Would a parent, guardian, or family friend be interested in helping coach?

Yes

No

What is their name and coaching experience?

PLAYER BACKGROUND

Previous Teams / Programs

Other Sports Played

Potential Scheduling Conflicts

UNIFORM

Michigan Premier uses the same uniforms each year (4-8th and 9-11th grade). If you are new to the program or in 4th or 9th grade, you will need to purchase a uniform.

Does the player need to purchase a uniform?

Yes

No

Uniform Size

Uniform Number Choice #1

Uniform Number Choice #2

Uniform Number Choice #3

PAYMENT

Tryout Registration Fee$15

I certify the information above is accurate.

I authorize emergency medical treatment if necessary.

WAIVER & RELEASE

I have read and agree to the terms of the waiver and release. waiver.

Parent/Guardian Signature:

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date

Month

Day

Year