Registration

Registration: 2019 5th Grade Football

$330.00

Create a unique username and password for the upcoming season below:

Username *
Password *
Confirm Password *
Participant's Information
Person Referred By First & Last Name:
Participant's First Name: *
Participant's Last Name: *
Participant's Primary Address: *
Address 2:
City: *
State: *
Zip: *
Participant's Home Phone (ten digit phone number with no spaces or dashes): *
Grade as of Fall 2019: *
Grade School Attending as of Fall : *
Date of Birth (mm-dd-yyyy): *
Parent/Legal Guardian Information (1 of 2)
Parents/Guardians First Name: *
Parents/Guardians Last Name: *
Cell Phone (ten digit phone number with no spaces or dashes): *
Email (Jr. Hilltopper emails will be sent here.) *
Confirm Email *
Parent/Legal Guardian Information (2 of 2)
Parents/Guardians First Name:
Parents/Guardians Last Name:
Cell Phone (ten digit phone number with no spaces or dashes):
Email (Only if different and you would like Jr. Hilltopper emails to also be sent here.)
Confirm Email
Emergency Contact Information Your son's Emergency Contact MUST be at least 18 years of age and someone other than a parent/ legal guardian.
Contact's First Name: *
Contact's Last Name: *
Contact's Home Phone (ten digit phone number with no spaces or dashes): *
Contact's Cell Phone (ten digit phone number with no spaces or dashes):
Contact's Relationship to Participant: *
Terms and Conditions Please read (by clicking each blue link below) each release or policy in its entirety and agree to all before proceeding.
I agree to the Risk of Injury Notification and the Release of Liability: *	Agreed
I agree to the Emergency Authorization: *	Agreed
I agree to the Travel Policy: *	Agreed
I agree to the Photographic Authorization: *	Agreed
I agree to the Participation Disclaimer: *	Agreed
I agree to the Volunteer Policy: *	Agreed
I agree to the Mandatory Fundraiser: *	Agreed
I agree to the Refund Policy: *	Agreed
I agree to the Code of Conduct: *	Agreed
I agree to the Physical Form Policy: *	Agreed
I acknowledge receiving, and agree to, the policies outlined in the Concussion and Head Injury Information Section in accordance with WI State Statute 118.293: *	Agreed
Signature By executing below this legally binding agreement, I certify that I have read in their entirety all of the above releases and policies, that I understand them, and agree to them.
Parent or Guardian Signature (Full Legal Name): *