Jacksonville Tribe Youth Football and Cheer Association

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Football Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

City:

State:

Zip Code:

* Home Phone:

* Birthdate:

* Age on May 31, 2014:

* Gender:

* Grade in Fall:

PARENT/GUARDIAN #1

* First Name:

* Last Name:

* Home Phone:

Work Phone:

Cell Phone:

EMail:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

Have you child had a physical in the last two years? If yes, please attach copy with form.:

Have team member played for JJYF before?:

LIST ANY BROTHERS/SISTERS PLAYING FOR JJYF(PLEASE INCLUDE GRADE AND AGE OF SIBLING)::

WAIVER INFORMATION

IN CONSIDERATION OF THE ABOVE MENTIONED CHILD, being allowed to participate in any way in the Jacksonville Jaguar Youth Football related events and activities, the undersigned acknowledges, appreciated and agrees that:
1. The risk of injury to my child from the activities involved in the program is significant, including the potential from permanent disability and death, and while particular rules, equipment, weight limits and personal discipline may reduce the risk of serious injury does exist, and
2. FOR MYSELF, MY SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my child’s participation; and
3. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation in the program, or the program itself, I will remove my child from participation and bring such to the attention of the nearest coach or official immediately; and
4. I myself, my spouse, my child and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE the coaches, trainers, administrators, team moms/dads, officers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable , owners and leasers of premises used to conduct the event (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY AND DEATH, loss or damage to person or property incident to my child’s involvement or participation in these programs to the fullest extent permitted by law.
5. I myself, my spouse, my child and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above releases from any and all liabilities incident to my involvement or participation in these programs to the fullest extent of the law.

I FURTHER AUTHORIZE THAT JJYF TO PROVIDE AND/OR SECURE EMERGENCY TREATMENT FOR AN INJURY OR ILLNESS OF MY CHILD, TO PERFORM FIRST AID WITHIN THE LIMITATIONS OF THERE TRAINING AND TAKE AND ADMIT, IF NECESSARY, MY CHILD TO A HOSPITAL OR MEDICAL CLINIC IN MY ABSENCE.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THAT I HAVE GIVEN UP THE SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY AND WITHOUT INDUCEMENT.

EQUIPMENT RESPONSIBILITY STATEMENT

I understand that the helmet, shoulder pads and other equipment furnished to my child is the property of JJYF and hereby agree to return it in the same condition (not withstanding normal wear and tear) at the end of the season. If the equipment is not returned to JJYF at the LAST GAME, I agree to reimburse JJYF the full replacement cost of damaged and missing equipment.

The following equipment listed below is required for every child playing football and is the responsibility of the parent/guardian to purchase. JJYF will provided player with Game Jersey, Helmets, Shoulder Pads and 1 Mouth Piece.

All items below should be purchased prior to the first practice of July 28, 2014.

Cleats
Game/Practice pants with pads

I/we agree with the Waiver and Equipment statement above *

Signature:

Date:

* indicates required fields

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Football Registration Form