Name of organization transferring from Bills Bucs Curdinal Colts Dolphins Falcons Jaguars Packers Panthers Raiders Seahawks Vikings

TAMPA BAY YOUTH FOOTBALL LEAGUE./FLAYAA REGISTRATION FORM

PLAYER-CHEERLEADER

Team/Organization Name	Bills Bucs Curdinal Colts Dolphins Falcons Jaguars Packers Panthers Raiders Seahawks Vikings	Date of birth	January February March April May June July August September October November December - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970
Age as of 7/31/2009		Age as of 9/31/2009

Participant Information

Child Last Name		Child First Name
Child Nick Name		Address
Home Phone		City
Zip		Country

Information request for FLYAA Tutorial Program

School		School ID#
Grade
Does the above named child participate in Free/Reduced Lunch Program		Yes No

Parent/Guardian Information

Family Medical Insurance

Participant Last Name		Participant First Name
Do you have primary insurance coverage for above child?		Yes No
Family Physician		Insurance Carrier
Allergies
Medical Conditions