Merritt Island Sports Association

Registration Form

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Name (Last, First) Date of Birth Phone

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Address City Zip Code

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Father Home Phone Work Phone

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Mother Home Phone Work Phone

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Insurance Company Policy Number

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League Age Weight Pant Size Shirt Size Hat Size

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Email Address

I/We as legal parent(s) or guardian of the applicant, submit this application for competing in the MISA. I/We agree to abide by the Merritt Island Sports Association Football and Cheerleading and Pop Warner Little Scholars rules and regulations.

All payments are due at signup. Refunds will be made on or before August 1, 2002. No refunds will be made on or after August 1, 2002.

I/We, the undersigned, as a parent or legal guardian, give my/our consent for the applicant to engage in activities as a representative of MISA and agree to the conditions set forth in this application. I/We understand that MISA Board Members and/or Mid-Florida Pop Warner Little Scholars will not be held legally and/or monetarily accountable for injuries incurred during activities and transportation to and from practices and games.

I/We, the undersigned as parent or legal guardian, agree to participate in league activities by contributing a MINIMUM of 5 hours of volunteer time to the league. Failure to contribute the required minimum amount of hours could result in your child’s inability to participate and continue on as a member of the league.

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Parent/Guardian Signature Date

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Parent/Guardian Signature Date

Medical Release

I/We authorize MISA to provide emergency medical treatment to _______________________________________________

Child’s Name (printed)

in the event that efforts to contact me/us are unsuccessful.

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Allergies/Conditions Emergency Contact

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Parent/Guardian Signature Date

Excellence through Teamwork, Sportsmanship and Citizenship

453-2283

Merritt Island Sports Association can be located on the Internet at www.misports.com