LOWER BUCKS FLAG FOOTBALL ASSOCIATION - (Levittown, PA)

Subscribe to our Newsletter

Fall 2024

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

LOWER BUCKS FLAG FOOTBALL ASSOCIATION WAIVER

I as parent or guardian of the registered participant hereby consent to his/her participation in the Lower Bucks Flag Football Program.

I am aware of the potential injury or harm to him/her and to others as a result of his/her participation in this program.

By agreeing to this waiver, I hereby release, absolve and hold harmless, Falls Township, Bristol Township, Bristol Township School District, Pennsbury School District, Lower Bucks Flag Football Association and it?s agents, board members, coaches, players, successors, facilitators and or assigns, now and forever into the future, from any and all liability of any kind, suffered as a result of, or in any way connected with his/her participation as an active participant and or spectator, in this flag football program. My son or daughter is in good health and has no condition or previous injuries that should keep him/her from participating in this flag football program.

By signing this waiver, I am agreeing to assume full and complete responsibility for all medical payments of any kind associated directly, with his/ her participation in this program. I will also assume full responsibility for all financial loss such as loss of wages both now and forever into the future as a result of injury or death.

I have read this document completely, I understand its contents and their significance and I am freely and willingly signing this agreement as parent/ legal guardian of the player named on this form as a participant in the Lower Bucks Flag Football Association Program. I am signing this as an adult over 18 years of age.
SIGN BY CHECKING THE AGREEMENT BOX

I/we agree with the above *

test

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form