CAPITAL AREA LADY GLADIATORS FOOTBALL CLUB 

215 Carriage Hill Drive

Fredericton, N.B., E3E 1A4
  

     2012 REGISTRATION FORM
  
NAME:______________________________________ BIRTHDAY D/M/Y:  __________
ADDRESS:__________________________________   AGE ON 31/12/12:___________
                    ________________________________ HEIGHT:__________________
POSTAL CODE:______________________________ WEIGHT:__________________
PHONE:_____________________________________  OTHER  SPORTS PLAYED:
SCHOOL OR JOB :___________________________  _________________________
MEDICARE # :_______________________________ _________________________
E-MAIL ADDRESS:_________________________________
  

PLEASE INDICATE THE AREA IN WHICH YOU LIVE (X).
  
LINCOLN: _____ SOUTHWOOD: _____ SKYLINE ACRES: _____
CITY CENTRE: _____ SILVERWOOD: _____ NEW MARYLAND: _____
HANWELL RD.: _____ WOODSTOCK RD.: _____ MARYSVILLE: _____
DEVON: _____ NASHWAAKSIS: _____ OROMOCTO: _____
BURTON: _____ GEARY: _____ ______________: _____
     

REGISTRATION    FEE:

 $160
T-SHIRT SIZE (CIRCLE ONE)

AS,   AM,  AL, AXL, A2XL, A3XL, A4XL
  
PLAYERS MUST BE AT LEAST 18 ON DECEMBER 31 IN THE YEAR OF PLAY.
PLAYERS GRADUATING FROM HIGH SCHOOL IN JUNE OF THE YEAR OF PLAY ARE ELIGIBLE TO PLAY IN THE MWFL.
Capital Area Lady Gladiators provide all football equipment, except footwear, as part of the registration fee.
  
DO YOU HAVE HEALTH INSURANCE THAT COVERS COVERS SPORTS INJURY RELATED COSTS
SUCH AS AMBULANCE, PHYSIOTHERAPY, MASSOTHERAPY, ETC.  ?       ______________
  

I understand that in a contact game like tackle football that injuries may occur. I hereby indemnify, hold harmless and release the MWFL, coaches and participants from any and all liability for all claims, demands losses, damage and costs including reasonable attorney’s fees, that arise out of or in connection with any personal injury, property damage, and or other loss suffered by me in connection with participation in the MWFL. I acknowledge that I am responsible for any and all medical expenses.
In the event of medical emergency and I am unavailable, I give my consent for whatever procedures are necessary by qualified medical staff. 
  
PLAYER SIGNATURE: _________________________________ DATE: _______________
  
Parental or Guardian Consent and Waiver for ALL players under the age of 18 at date of registration. 

I authorize my daughter to participate in the Maritime Women's Football League. I understand that in a contact game like tackle football that injuries may occur.  I hereby indemnify, hold harmless and release the MWFL, coaches and participants from any and all liability for all claims, demands losses, damage and costs including reasonable attorney’s fees, that arise out of or in connection with any personal injury, property damage, and or other loss suffered by my daughter in connection with participation in the MWFL. I acknowledge that I am responsible for any and all medical expenses.
In the event of medical emergency and I am unavailable, I give my consent for whatever procedures are necessary by qualified medical staff. 
     
PARENT OR GUARDIAN SIGNATURE: _______________________________ DATE: _______________