Staff Registration

General Info
* Please note that the information you provide will also be shared with our athletic therapists *
Name*
First Last
Address*
Street Address App. City State / Province / Region ZIP / Postal Code
Email*
Phone*
Birthdate*
DD slash MM slash YYYY
Medicare card*
Role*
- Coach
- Assistant Coach
- Manager
Coaching #
EMERGENCY CONTACT
Name*
First Last
Phone*
MEDICAL INFORMATION
Medical condition*
Please list all known allergies*
Please list all medications, including for asthma:*
*
As a volunteer for the Greenfield Park Packers Football Association, I hereby consent for the executive board to conduct a background check for security purposes.
*
I hereby pledge to abide by and uphold the values and standards of the following at all time: 1-Association's Contitution; 2- Green & Gold Code

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General Info