REGISTRATION FORM | Bombsquad

Bomb Squad Tackle Football Registration

Please take a moment to fill out the form.

Full Name of Child

Date of Birth:

Age:

Gender:

Address

City:

State:

ZIP Code:

Parent/Guardian Information:

Parent/Guardian Name

Relationship to Child:

Phone Number:

Emergency Contact Information:

Emergency Contact Name:

Relationship to Child:

Phone Number:

Medical Information:

Does your child have any medical conditions or allergies? (Please specify)

Are there any physical limitations or disabilities we should be aware of?

Insurance Information:

Insurance Provider:

Policy Number:

Group Number:

Media Consent:

Do you grant permission for your child's photograph or video to be used for promotional purposes? (Please circle one) Yes / No

FEES:

Non-Refundable Application Fee: $50

Registration Fee:

New Athlete: $400

Returning Athlete (owns equip): $200

Agreement and Release: I, the undersigned, as the parent or legal guardian of the child listed above, hereby give my consent for my child to participate in the youth football program organized by TCEP for the Bomb Squad Football Team. I understand that there are inherent risks associated with participating in physical activities and sports and I acknowledge that my child's participation is voluntary. I agree to release, indemnify, and hold harmless TCEP, Chaminade, Show Me Football League and its staff, coaches, and volunteers from any liability, injury, or loss that may occur during my child's participation in the youth football program.

Parent/Guardian Signature Name

Date: required

Please complete this registration form and submit it along with the registration fee to the Bomb Squad administrator. If you have any questions or require additional information, please contact us at 314-606-3578 or the Bomb Squad Groupme.

Thank you for registering your child for our youth football program! We look forward to a fun and successful season.

Thanks for Registering!