form community league | Hialeah City FC

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Payer's name*

Payer's Lastname*

Payer's date of birth*

Month

Day

Year

Does your son have any medical conditions?*

Yes

No

Please describe the medical condition

Has the child played any sports before?*

Yes

No

If so, please write the name of the sport.

Is the child currently enrolled in a sports academy?*

Yes

No

If so, please write the name of the academy and the sport they teach

Legal guardian's name

Legal guardian's last name

Phone Number*

Email

Address 1

City name

State name

Legal Guardian Signature*

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Please provide the name and phone number of someone we can contact in case of an emergency

Full Name*

Contact 2*

family relationship

Mother

Father

Uncle

Grandfather / Grandmother

Brother

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Otro

Accept Terms and Conditions

General Waiver

CLUB CONTACT

4200 W 8 AVE HIALEAH FL, 33012

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