Syosset Youth Football and Cheerleading League

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Syosset Youth Football & Cheerleading Registration

* Date:

Cheerleading

Football

PARTICIPANT INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Age as of Dec 1, 2016:

Email:

Gender:

Grade as of September 2016:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

Home Phone:

Work Phone:

* Cell Phone:

Volunteer:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

Volunteer:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

The undersigned for ourselves, our heirs, executors and administrators waive, release and forever discharge Syosset Youth Football & Cheerleading League, its staff, volunteers, officers, agents, employees, representatives, successors, Syosset School District and assigned of and from all rights and claims for damages injuries or loss person or property which sustain or occur during participation in football or cheerleading activities whether paid damages, injury or loss are due to negligence or not.
I certify that applicant is in good medical condition and allow him/her to participate in Syosset Youth Football & Cheerleading League activities.
Medical treatment: we being the guardian(s)of the applicant authorize Syosset Youth Football & Cheerleading League and its agents permission to request medical treatment as is necessary to insure the well being of our dependent. Health Insurance Carrier

I/We agree with the above *

I understand that the Syosset Youth Football & Cheerleading League provides equipment for the season. Any equipment lost/stolen, etc. or not returned in its proper state will result in a fee due the league. The league will charge your credit card only if said equipment in not returned in its proper state.

I /We agree with the above *

* indicates required fields

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

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Syosset Youth Football & Cheerleading Registration