2009 – Maverick Flag Football League

General Registration Information:

____________________________ ___________ ______________________________

(Name of Participant) (Current Grade) (Name of Current School)

_______________________________________ _______ _______________________

(Address) (State) (Zip Code)

____________________________ __________________________________________

(Home Phone) (Name of High School you will most likely attend)

General Football Information:

What position do you wish to play: DL LB DB OL QB RB WR

(Circle Two)

Mail the 3 registration pages to: Darrin Brown, Head Football Coach

La Costa Canyon High School

One Maverick Way

Carlsbad, CA 92009

Or Turn them in at the LCC Football Meeting, March 11, 5:30pm.

1. PLEASE FILL OUT ALL FORMS COMPLETELY WITH ALL NECESSARY SIGNATURES.

2. THE PART 3 – HEALTH FORM DOES NOT QUALIFY AS A PHYSICAL FOR FRESHMAN FOOTBALL.

3. THE PART 3 HEALTH FORM ONLY REQUIRES DOCTORS SIGNATURE INDICATING YOUR CHILD IS IN GOOD HEALTH TO PARTICPATE (OFTEN DOCTORS WILL SIGN THE FORM VIA FAX).

4. YOUR SIGNATURE BELOW INDICATES YOU HAVE READ AND UNDERSTAND THE ABOVE STATED ITEMS.

x

FOR OFFICIAL USE ONLY

Date Registration Received:_____________ Date Registration Verified:_____________

Paid by: CASH CHECK Check Number:____________ Amount:_____________

Please attach your check for $120 made payable to Mavericks Football here.