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WYFBL Tackle Player Authorization Form
PLAYER INFORMATION
Town/Team:
Coach:
*
First Name:
*
Last Name:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
*
Grade:
K
1
2
3
4
5
6
7
8
9
10
11
12
TO BE FILLED IN BY COACH
Location of Weigh In:
Weight:
Weigh In Date:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
Player size:
X
XX
EX
WAIVER INFORMATION
Waiver:
I state that my child/registrant is in satisfactory health with no specific health problems. As guardian for my child/registrant, I hereby acknowledge that I am aware of the risks involved in the sport for which I am registering my child/registrant and that by enrolling in the program, I am expressly assuming all risks. I agree that I have adequate medical insurance coverage if the risk of injury occurs. I also giving permission, in case of injury, for a coach to take my child/registrant to a hospital for treatment, including the evaluation of injuries, x-rays and needed care. I hereby release the Westchester Youth Football League, its Board and all volunteer coaches, employees and volunteers of any liability whatsoever in connection with any injuries my child/registrant may sustain as a result of participation in the program sponsored by the Westchester Youth Football League.
I/we agree with the above
*
Parents Code of Conduct:
I pledge to support my child's /registrants participation in youth sports by agreeing to the following: I will remember that youth sports are for the children. I will encourage good sportsmanship by behaving in a courteous manner and demonstrating positive support for all players, coaches and officials. I will place the emotional and physical wellbeing of the children ahead of any personal desire to win. I will demand an environment that is free from tobacco, alcohol and drugs and I will refrain from their use at all youth sports events. I will require my child to treat other players, coaches, fans and officials with respect. I acknowledge that I am accountable for my own conduct, as well as the conduct of those attending on my behalf or at my invitation. If at any point I have a concern about my child's wellbeing, I will privately contact my child's coach or a member of the organization running the sport and will follow the grievance procedures established by the organization running the sport. I will never air a concern on the field of play or in the presence of the children. I have read and understood this Parents' Code of Conduct and I acknowledge that failure to abide by it will result in my removal from an event and possible suspension from participation in The Westchester Youth Football League programs.
As legal parent/guardian of the participant described in this certification, I hereby verify by my signature below that all the information is true and accurate. I understand that falsifying any information in this document potentially endangers the reputation and financial status of the league as well as the health and safety of the players in the league. I understand that falsifying information may be subject to legal action.
Your child is participating on a team that has players that may be older or one grade level above his own. I am aware of the risks and waive any liability with the Westchester Youth Football League, Its Board Members or Volunteers. (Please check with your head coach or league Representative if you have any questions)
I/we agree with the above
*
PARENT/GUARDIAN #1
*
First name:
*
Last name:
*
EMail:
*
Cell Phone:
*
Address:
* indicates required fields