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2022 VMFL Football Registration
Please complete and submit a new form for each player.
Player Information
First Name
*
Last Name
*
Address
*
Address Line 2
City
*
State
*
Please select
Please select
AL
AK
AR
AZ
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
Home Phone
Mobile Phone
Email
*
Gender
*
Birthdate
*
Birth Place/Country
*
Emergency Contact First Name
*
Emergency Contact Last Name
*
Emergency Contact Primary Phone
*
Has participant ever been rendered unconscious or suffered a concussion?
*
No
Yes
If so, how many times?
Has participant ever suffered a back injury?
*
No
Yes
If so, how many times?
If yes, when?
Allergies
Payment Information
Credit Card Number
*
Exp Month (mm)
*
Exp Year (yy)
*
CVC Code
*
Submit
