Ascension Cougars Youth Football - (Gonzales, LA)

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ASCENSION COUGARS YOUTH FOOTBALL 2025 Season Registration Form

* Today's Date:

PLAYER INFORMATION

* Team:

* First Name:

Middle Initial:

* Last Name:

* Street:

State:

* City:

* Zip Code:

* Home Phone:

* Age:

* Gender:

Height:

Weight:

Jersey Size:

Pants Size:

Grade:

School:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

* Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

As the parent and legal guardian of the above name player/cheerleader, I give my consent for emergency medical care performed by any duly board licenses/certified Medical or Dentistry Practitioners. This care may be given whatever conditions are necessary to preserve life, limb, or well being of my dependent.

Signature of Parent/Guardian:

Date:

I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Football League and the Ascension Cougars, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associate with athletics and in consideration for the Football League and the Ascension Cougars accepting the registrant for programs and activities (the Programs), I hereby release, discharge and/or otherwise indemnify the Football League and Ascension Cougars Organization, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of facilities utilized for Programs, against any claim by or on behalf of the registrant as a result of the registrants participation in the programs and/or being transported to or from the same which transportation I hereby authorize.

Signature of Parent/Guardian:

Date:

All funds received by the Ascension Cougars for associated activities, registration and/or donations will not be refunded after the first week of practice.

Signature of Parent/Guardian:

Date:

I/we agree with the above *

* indicates required fields